Venous Thromboembolic Prophylaxis after Elective Total Hip Arthroplasty

Elective total hip arthroplasty is a common orthopaedic procedure that has been proven to relieve pain and reliably improves the quality of life of its patients. However, patients having a total hip arthroplasty are among those at greatest risk for venous thromboembolic disease. Therefore, most orthopaedic surgeons use routine prophylaxis. Although several agents have been shown to reduce the risk of thromboembolic disease, there is no clear preference for a particular agent in elective total hip arthroplasty. This evidence-based review focuses on the efficacy and safety of the agents that currently are used for prophylaxis against deep venous thrombosis. These agents include warfarin, low-molecular-weight heparin, fondaparinux, aspirin, and mechanical devices. Furthermore, the influence of shorter hospital stays on duration of prophylaxis and screening will be discussed. The most effective prophylactic agents for patients after total hip arthroplasty include low-molecular-weight heparin, warfarin, and fondaparinux. Pneumatic compression devices have been proven to reduce distal thromboembolic events but multi-center, randomized studies need to be done to determine the efficacy of mechanical prophylaxis with short hospital stays. The selection of a prophylaxis regimen is a balance between efficacy and safety, and individual patient factors can influence the prophylaxis regimen that is used.