VENOUS THROMBOEMBOLISM CHEMOPROPHYLAXIS IN TOTAL HIP AND KNEE ARTHROPLASTY A Critical Analysis Review

Numerous pharmacological methods of venous thromboembolism prophylaxis are currently utilized, each with advantages and limitations. Warfarin has long been demonstrated to have efficacy, but has variable patient response and requires outpatient monitoring. Low molecular-weight heparins also have long been demonstrated to have established efficacy, but require outpatient subcutaneous injections, which raises concern for compliance. Factor-Xa and direct thrombin inhibitors may be taken orally but lack easily obtainable reversal agents. Aspirin is an appealing choice because it is inexpensive, is taken orally, requires no laboratory monitoring, and may have similar efficacy; however, it still lacks appropriately powered randomized controlled trials to substantiate its efficacy. A surgeon must consider the efficacy, complication profile, and cost in the setting of patient competence and compliance on a case-by case basis when choosing a prophylactic agent.