What are the AAOS guidelines for the prevention of venous thromboembolism (VTE) in patients undergoing orthopedic surgery?

Updated: Nov 05, 2020
  • Author: Vera A De Palo, MD, MBA, FCCP; Chief Editor: Vinod K Panchbhavi, MD, FACS  more...
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Answer

The 2011 guidelines from the American Academy of Orthopaedic Surgeons (AAOS) on preventing VTE in patients undergoing elective hip and knee arthroplasty included the following recommendations [7, 8] :

  • Recommend against routine postoperative duplex ultrasonography screening
  • Assess risk of previous VTE
  • Assess risk for bleeding
  • Suggest discontinuance of antiplatelet agents before undergoing elective hip or knee arthroplasty
  • Suggest pharmacologic agents and/or mechanical compressive devices for prevention of VTE in those undergoing elective hip or knee arthroplasty who are not at elevated additional risk for VTE or bleeding
  • Pharmacologic prophylaxis and mechanical compressive devices for those who have had previous VTE and are undergoing elective hip or knee arthroplasty
  • Mechanical compressive devices for those who have had known bleeding disorder and/or active liver disease and are undergoing elective hip or knee arthroplasty
  • Patients should undergo early mobilization following elective hip and knee arthroplasty
  • Use of neuraxial anesthesia for those undergoing elective hip or knee arthroplasty to help limit blood loss
  • No recommendation can be made for or against the use of inferior vena cava (IVC) filters

A study by Khokhar et al indicated that there is a lack of uniformity among venous thromboprophylactic guidelines for elective knee arthroplasty. Reviewing 12 guidelines, the investigators found that although almost all of them advocated the use of LMWH and fondaparinux (a synthetic, pentasaccharide anticoagulant), recommendations for other drugs varied, as did drug dosages, duration, and recommendation grades. [9]

In an article addressing the differences between the antithrombotic guidelines of the American College of Chest Physicians (ACCP) and those of the AAOS, the authors noted that recommendation variations were based on methodology and evidence differences. [10] With updates to these two more popular VTE guidelines, similar recommendations were offered that focus on minimizing symptomatic VTE and bleeding complications. [11]


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