Venous thromboembolism and its prophylaxis in elective knee arthroplasty: An international perspective |
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| Authors: | Arif Khokhar Aswin Chari David Murray Martin McNally Hemant Pandit |
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| Affiliation: | 1. Cartilage Restoration Program, OSU Sports Medicine Center and The Sports Health & Performance Institute, The Ohio State University, United States;2. Department of Orthopaedics, The Ohio State University College of Medicine, United States;3. Department of Mechanical & Aerospace Engineering, The Ohio State University College of Engineering, United States;4. Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, United States;1. University of São Paulo, São Paulo, Brazil;2. Brigham and Women''s Hospital, Harvard Medical School, Boston, MA, USA;1. Laboratory of Human Anatomy, University of Glasgow, Glasgow, G12 8QQ, United Kingdom;2. Department of Orthopaedics, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, West Dunbartonshire, G81 4DY, United Kingdom;1. Warren Alpert Medical School of Brown University, United States;2. Department of Orthopaedics, Warren Alpert Medical School of Brown University, United States;3. Department of Community Health, Warren Alpert Medical School of Brown University, United States |
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| Abstract: | IntroductionPatients undergoing knee arthroplasty are at high risk of developing post-operative deep vein thrombosis (DVT) or a pulmonary embolus (PE). Despite best efforts, the best prophylaxis for thromboembolic disease remains controversial. This article aims to update the reader on the newest guidelines concerning venous thromboembolism (VTE) prophylaxis for elective knee arthroplasty, highlighting their inconsistencies and why variations in recommendations exist.MethodsThe Medline database and the Internet were searched for VTE prophylaxis guidelines in English. 12 guidelines were found and compared. The comparison looked at the recommendations made, the grade of recommendation, the level of evidence available for these recommendations and any inconsistencies between the guidelines.ResultsNearly all the guidelines advocate the use of low molecular weight heparin (LMWH) and Fondaparinux. There is little consensus in terms of other recommended drugs, the doses, duration and their recommendation grades. There are marked differences in the methodologies adopted by the different guideline working-groups.ConclusionThere is still uncertainty about the optimal methods of thromboprophylaxis in elective knee arthroplasty. Although there are always going to be disagreements about the endpoints amongst guideline makers, guidelines should achieve uniformity in their reporting of end-points, criteria for levels of evidence and recommendation grades, facilitating the clinician's decision-making process.Level of evidenceIIa. |
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