The Current Status of Venous Thromboembolism Prophylaxis Following Total Joint Arthroplasty
Main Article Content
Abstract
Background: A variety of local and systemic factors contribute to the increased risk of venous thromboembolism (VTE) following total knee arthroplasty (TKA) and total hip arthroplasty (THA). The optimal regimen(s) for VTE prophylaxis are not conclusively defined at the present. This review is focused on the most current data on the outcomes of using various VTE prophylaxis following TKAs and THAs in the United State (U.S.)
Methods: A review of the literature over the past 5 years was undertaken. We in particular focused on the data comparing the efficacy and the safety of different agents.
Results: The commonly used VTE prophylaxis agents in the U.S. include: low-molecular-weight heparin, the new oral anticoagulants (factor Xa inhibitors), warfarin, and aspirin. Aspirin in particular has gained popularity over the past few years. This is principally due to several factors: less bleeding, equal efficacy, and the ease of use. Most surgeons use a “multi-modal” protocol including early mobilization, mechanical prophylaxis, and chemoprophylaxis.
Conclusion: There is no conclusive evidence with regard to what agent(s) are the most efficacious and the safest in VTE prophylaxis following TKAs and THAs. There is however general agreement between the major guidelines from the professional associations of orthopedic surgery, and from the non-orthopedic disciplines. It is important to risk-stratify each patient, and to apply the most appropriate VTE prophylaxis.
Article Details
How to Cite
RINEHART, Dustin B.; NGUYEN, Ivy; HUO, Michael H..
The Current Status of Venous Thromboembolism Prophylaxis Following Total Joint Arthroplasty.
Medical Research Archives, [S.l.], v. 9, n. 6, june 2021.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/2477>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v9i6.2477.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Parvizi J, Huang R, Rezapoor M, Bagheri B, Maltenfort MG. Individualized risk model for venous thromboembolism after total joint arthroplasty. The Journal of arthroplasty. 2016 Sep 1;31(9):180-6.
2. Lieberman JR, Geerts WH. Prevention of venous thromboembolism after total hip and knee arthroplasty. JBJS. 1994 Aug 1;76(8):1239-50.
3. Mori N, Kimura S, Onodera T, Iwasaki N, Nakagawa I, Masuda T. Use of a pneumatic tourniquet in total knee arthroplasty increases the risk of distal deep vein thrombosis: a prospective, randomized study. The Knee. 2016 Oct 1;23(5):887-9.
4. Zhang ZH, Shen B, Yang J, Zhou ZK, Pei FX. Risk factors for venous thromboembolism of total hip arthroplasty and total knee arthroplasty: a systematic review of evidences in ten years. BMC musculoskeletal disorders. 2015 Dec;16(1):1-4.
5. Binns MA, Pho RO. Femoral vein occlusion during hip arthroplasty. Clinical orthopaedics and related research. 1990 Jun 1(255):168-72.
6. Planes A, Vochelle N, Fagola M. Total hip replacement and deep vein thrombosis. A venographic and necropsy study. JBJS. British volume. 1990 Jan;72(1):9-13.
7. Mednick RE, Alvi HM, Morgan CE, Stover MD, Manning DW. Femoral vein blood flow during a total hip arthroplasty using a modified Heuter approach. The Journal of arthroplasty. 2015 May 1;30(5):786-9.
8. Gordon RJ, Lombard FW. Perioperative venous thromboembolism: a review. Anesthesia & Analgesia. 2017 Aug 1;125(2):403-12
9. Gitel SN, Salvati EA, Wessler ST, Robinson Jr HJ, Worth Jr MH. The effect of total hip replacement and general surgery on antithrombin III in relation to venous thrombosis. JBJS. American volume. 1979 Jul 1;61(5):653-6.
10. d'Angelo A, Kluft C, Verheijen JH, Rijken DC, Mozzi E, Mannucci PM. Fibrinolytic shut‐down after surgery: impairment of the balance between tissue‐type plasminogen activator and its specific inhibitor. European journal of clinical investigation. 1985 Dec;15(6):308-12.
11. Warren JA, Sundaram K, Anis HK, Kamath AF, Higuera CA, Piuzzi NS. Have venous thromboembolism rates decreased in total hip and knee arthroplasty?. The Journal of arthroplasty. 2020 Jan 1;35(1):259-64.
12. Jaffer AK, Barsoum WK, Krebs V, Hurbanek JG, Morra N, Brotman DJ. Duration of anesthesia and venous thromboembolism after hip and knee arthroplasty. Mayo Clinic Proceedings. 2005 Jun 1 (Vol. 80, No. 6, pp. 732-738).
13. Zhang H, Mao P, Wang C, Chen D, Xu Z, Shi D, Dai J, Yao Y, Jiang Q. Incidence and risk factors of deep vein thrombosis (DVT) after total hip or knee arthroplasty: a retrospective study with routinely applied venography. Blood Coagulation & Fibrinolysis. 2017 Mar 1;28(2):126-33.
14. Ruppert A, Steinle T, Lees M. Economic burden of venous thromboembolism: a systematic review. Journal of medical economics. 2011 Jan 1;14(1):65-74.
15. Geerts WH, Heit JA, Clagett GP, Pineo GF, Colwell CW, Anderson FA, Wheeler HB. Prevention of venous thromboembolism. Chest. 2001 Jan 1;119(1):132S-75S.
16. Morris GK, Henry AP, Preston BJ. Prevention of deep-vein thrombosis by low-dose heparin in patients undergoing total hip replacement. The Lancet. 1974 Oct 5;304(7884):797-800.
17. Mannucci PM, Citterio LE, Panajotopoulos N. Low-dose heparin and deep-vein thrombosis after total hip replacement. Thrombosis and haemostasis. 1976;36(04):157-64.
18. Moskovitz PA, Ellenberg SS, Feffer HL, Kenmore PI, Neviaser RJ, Rubin BE, Varma VM. Low-dose heparin for prevention of venous thromboembolism in total hip arthroplasty and surgical repair of hip fractures. JBJS. American volume. 1978 Dec 1;60(8):1065-70.
19. Hampson WG, Lucas HK, Harris FC, Roberts PH, McCall IW, Jackson PC, Powell NL, Staddon GE. Failure of low-dose heparin to prevent deep-vein thrombosis after hip-replacement arthroplasty. The Lancet. 1974 Oct 5;304(7884):795-7.
20. Imperiale TF, Speroff T. A meta-analysis of methods to prevent venous thromboembolism following total hip replacement. JAMA. 1994 Jun 8;271(22):1780-5.
21. Leyvraz PF, Richard J, Bachmann F, van Melle G, Treyvaud JM, Livio JJ, Candardjis G. Adjusted versus fixed-dose subcutaneous heparin in the prevention of deep-vein thrombosis after total hip replacement. New England Journal of Medicine. 1983 Oct 20;309(16):954-8.
22. Francis CW, Marder VJ, Evarts CM, Yaukoolbodi S. Two-step warfarin therapy: prevention of postoperative venous thrombosis without excessive bleeding. JAMA. 1983 Jan 21;249(3):374-8.
23. Francis CW, Pellegrini VD, Marder VJ, Totterman S, Harris CM, Gabriel KR, Azodo MV, Leibert KM. Comparison of warfarin and external pneumatic compression in prevention of venous thrombosis after total hip replacement. JAMA. 1992 Jun 3;267(21):2911-5.
24. Harris WH, Salzman EW, DeSanctis RW, Coutts RD. Prevention of venous thromboembolism following total hip replacement: Warfarin vs dextran 40. JAMA. 1972 Jun 5;220(10):1319-22.
25. Harris WH, Salzman EW, Athanasoulis C, Waltman AC, Baum S, Desanctis RW. Comparison of warfarin, low-molecular-weight dextran, aspirin, and subcutaneous heparin in prevention of venous thromboembolism following total hip replacement. JBJS. 1974 Dec 1;56(8):1552-62.
26. Anderson Jr FA, Hirsh J, White K, Fitzgerald Jr RH, Hip and Knee Registry Investigators. Temporal trends in prevention of venous thromboembolism following primary total hip or knee arthroplasty 1996–2001: findings from the Hip and Knee Registry. Chest. 2003 Dec 1;124(6):349S-56S.
27. O'Donnell M, Linkins LA, Kearon C, Julian J, Hirsh J. Reduction of out-of-hospital symptomatic venous thromboembolism by extended thromboprophylaxis with low-molecular-weight heparin following elective hip arthroplasty: a systematic review. Archives of internal medicine. 2003 Jun 9;163(11):1362-6.
28. Haas S. Prevention of venous thromboembolism: recommendations based on the international consensus and the American College of Chest Physicians sixth consensus conference on antithrombotic therapy. Clinical and Applied Thrombosis/Hemostasis. 2001 Jul;7(3):171-7.
29. Barrack RL. Current guidelines for total joint VTE prophylaxis: dawn of a new day. The Journal of bone and joint surgery. British volume. 2012 Nov;94(11_Supple_A):3-7.
30. Cafri G, Paxton EW, Chen Y, Cheetham CT, Gould MK, Sluggett J, Bini SA, Khatod M. Comparative effectiveness and safety of drug prophylaxis for prevention of venous thromboembolism after total knee arthroplasty. The Journal of arthroplasty. 2017 Nov 1;32(11):3524-8.
31. Markel DC, York S, Liston Jr MJ, Flynn JC, Barnes CL, Davis III CM, AAHKS Research Committee. Venous thromboembolism: management by American association of hip and knee surgeons. The Journal of arthroplasty. 2010 Jan 1;25(1):3-9.
32. Huang HF, Li SS, Yang XT, Xie Q, Tian XB. Rivaroxaban versus enoxaparin for the prevention of venous thromboembolism after total knee arthroplasty: a meta-analysis. Medicine. 2018 Nov;97(48).
33. Lindquist DE, Stewart DW, Brewster A, Waldroup C, Odle BL, Burchette JE, El-Bazouni H. Comparison of postoperative bleeding in total hip and knee arthroplasty patients receiving rivaroxaban, enoxaparin, or aspirin for thromboprophylaxis. Clinical and Applied Thrombosis/Hemostasis. 2018 Nov;24(8):1315-21.
34. Ricket AL, Stewart DW, Wood RC, Cornett L, Odle B, Cluck D, Freshour J, El-Bazouni H. Comparison of postoperative bleeding in total hip and knee arthroplasty patients receiving rivaroxaban or enoxaparin. Annals of Pharmacotherapy. 2016 Apr;50(4):270-5.
35. Huang RC, Parvizi J, Hozack WJ, Chen AF, Austin MS. Aspirin is as effective as and safer than warfarin for patients at higher risk of venous thromboembolism undergoing total joint arthroplasty. The Journal of arthroplasty. 2016 Sep 1;31(9):83-6.
36. Bingham JS, Salib CG, Labban K, Morrison Z, Spangehl MJ. A dedicated anticoagulation clinic does not improve postoperative management of warfarin after total joint arthroplasty. Arthroplasty today. 2018 Sep 1;4(3):340-2.
37. Nam D, Sadhu A, Hirsh J, Keeney JA, Nunley RM, Barrack RL. The use of warfarin for DVT prophylaxis following hip and knee arthroplasty: how often are patients within their target INR range?. The Journal of arthroplasty. 2015 Feb 1;30(2):315-9.
38. Cho SE, Delate T, Witt DM, Clark NP. Thromboembolic and bleeding outcomes of extended duration low-intensity warfarin following elective total knee arthroplasty. Thrombosis research. 2015 Feb 1;135(2):267-71.
39. Hood BR, Cowen ME, Zheng HT, Hughes RE, Singal B, Hallstrom BR. Association of aspirin with prevention of venous thromboembolism in patients after total knee arthroplasty compared with other anticoagulants: a noninferiority analysis. JAMA surgery. 2019 Jan 1;154(1):65-72.
40. Radzak KN, Wages JJ, Hall KE, Nakasone CK. Rate of transfusions after total knee arthroplasty in patients receiving Lovenox or high-dose aspirin. The Journal of arthroplasty. 2016 Nov 1;31(11):2447-51.
41. Agaba P, Kildow BJ, Dhotar H, Seyler TM, Bolognesi M. Comparison of postoperative complications after total hip arthroplasty among patients receiving aspirin, enoxaparin, warfarin, and factor Xa inhibitors. Journal of orthopaedics. 2017 Dec 1;14(4):537-43.
42. Bala A, Murasko MJ, Burk DR, Huddleston 3rd JI, Goodman SB, Maloney WJ, Amanatullah DF. Venous thromboprophylaxis after total hip arthroplasty: aspirin, warfarin, enoxaparin, or factor Xa inhibitors?. HIP International. 2020 Sep;30(5):564-71.
43. Parvizi J, Huang R, Restrepo C, Chen AF, Austin MS, Hozack WJ, Lonner JH. Low-dose aspirin is effective chemoprophylaxis against clinically important venous thromboembolism following total joint arthroplasty: a preliminary analysis. JBJS. 2017 Jan 18;99(2):91-8.
44. Rondon AJ, Shohat N, Tan TL, Goswami K, Huang RC, Parvizi J. The use of aspirin for prophylaxis against venous thromboembolism decreases mortality following primary total joint arthroplasty. JBJS. 2019 Mar 20;101(6):504-13.
45. Hamilton WG, Reeves JD, Fricka KB, Goyal N, Engh GA, Parks NL. Mechanical thromboembolic prophylaxis with risk stratification in total knee arthroplasty. The Journal of arthroplasty. 2015 Jan 1;30(1):43-5.
46. Pavon JM, Adam SS, Razouki ZA, McDuffie JR, Lachiewicz PF, Kosinski AS, Beadles CA, Ortel TL, Nagi A, Williams Jr JW. Effectiveness of intermittent pneumatic compression devices for venous thromboembolism prophylaxis in high-risk surgical patients: a systematic review. The Journal of arthroplasty. 2016 Feb 1;31(2):524-32.
47. Pierce TP, Cherian JJ, Jauregui JJ, Elmallah RK, Lieberman JR, Mont MA. A current review of mechanical compression and its role in venous thromboembolic prophylaxis in total knee and total hip arthroplasty. The Journal of arthroplasty. 2015 Dec 1;30(12):2279-84.
48. Arsoy D, Giori NJ, Woolson ST. Mobile compression reduces bleeding-related readmissions and wound complications after THA and TKA. Clinical orthopaedics and related research. 2018 Feb;476(2):381.
49. Snyder MA, Sympson AN, Scheuerman CM, Gregg JL, Hussain LR. Efficacy in deep vein thrombosis prevention with extended mechanical compression device therapy and prophylactic aspirin following total knee arthroplasty: a randomized control trial. The Journal of arthroplasty. 2017 May 1;32(5):1478-82.
2. Lieberman JR, Geerts WH. Prevention of venous thromboembolism after total hip and knee arthroplasty. JBJS. 1994 Aug 1;76(8):1239-50.
3. Mori N, Kimura S, Onodera T, Iwasaki N, Nakagawa I, Masuda T. Use of a pneumatic tourniquet in total knee arthroplasty increases the risk of distal deep vein thrombosis: a prospective, randomized study. The Knee. 2016 Oct 1;23(5):887-9.
4. Zhang ZH, Shen B, Yang J, Zhou ZK, Pei FX. Risk factors for venous thromboembolism of total hip arthroplasty and total knee arthroplasty: a systematic review of evidences in ten years. BMC musculoskeletal disorders. 2015 Dec;16(1):1-4.
5. Binns MA, Pho RO. Femoral vein occlusion during hip arthroplasty. Clinical orthopaedics and related research. 1990 Jun 1(255):168-72.
6. Planes A, Vochelle N, Fagola M. Total hip replacement and deep vein thrombosis. A venographic and necropsy study. JBJS. British volume. 1990 Jan;72(1):9-13.
7. Mednick RE, Alvi HM, Morgan CE, Stover MD, Manning DW. Femoral vein blood flow during a total hip arthroplasty using a modified Heuter approach. The Journal of arthroplasty. 2015 May 1;30(5):786-9.
8. Gordon RJ, Lombard FW. Perioperative venous thromboembolism: a review. Anesthesia & Analgesia. 2017 Aug 1;125(2):403-12
9. Gitel SN, Salvati EA, Wessler ST, Robinson Jr HJ, Worth Jr MH. The effect of total hip replacement and general surgery on antithrombin III in relation to venous thrombosis. JBJS. American volume. 1979 Jul 1;61(5):653-6.
10. d'Angelo A, Kluft C, Verheijen JH, Rijken DC, Mozzi E, Mannucci PM. Fibrinolytic shut‐down after surgery: impairment of the balance between tissue‐type plasminogen activator and its specific inhibitor. European journal of clinical investigation. 1985 Dec;15(6):308-12.
11. Warren JA, Sundaram K, Anis HK, Kamath AF, Higuera CA, Piuzzi NS. Have venous thromboembolism rates decreased in total hip and knee arthroplasty?. The Journal of arthroplasty. 2020 Jan 1;35(1):259-64.
12. Jaffer AK, Barsoum WK, Krebs V, Hurbanek JG, Morra N, Brotman DJ. Duration of anesthesia and venous thromboembolism after hip and knee arthroplasty. Mayo Clinic Proceedings. 2005 Jun 1 (Vol. 80, No. 6, pp. 732-738).
13. Zhang H, Mao P, Wang C, Chen D, Xu Z, Shi D, Dai J, Yao Y, Jiang Q. Incidence and risk factors of deep vein thrombosis (DVT) after total hip or knee arthroplasty: a retrospective study with routinely applied venography. Blood Coagulation & Fibrinolysis. 2017 Mar 1;28(2):126-33.
14. Ruppert A, Steinle T, Lees M. Economic burden of venous thromboembolism: a systematic review. Journal of medical economics. 2011 Jan 1;14(1):65-74.
15. Geerts WH, Heit JA, Clagett GP, Pineo GF, Colwell CW, Anderson FA, Wheeler HB. Prevention of venous thromboembolism. Chest. 2001 Jan 1;119(1):132S-75S.
16. Morris GK, Henry AP, Preston BJ. Prevention of deep-vein thrombosis by low-dose heparin in patients undergoing total hip replacement. The Lancet. 1974 Oct 5;304(7884):797-800.
17. Mannucci PM, Citterio LE, Panajotopoulos N. Low-dose heparin and deep-vein thrombosis after total hip replacement. Thrombosis and haemostasis. 1976;36(04):157-64.
18. Moskovitz PA, Ellenberg SS, Feffer HL, Kenmore PI, Neviaser RJ, Rubin BE, Varma VM. Low-dose heparin for prevention of venous thromboembolism in total hip arthroplasty and surgical repair of hip fractures. JBJS. American volume. 1978 Dec 1;60(8):1065-70.
19. Hampson WG, Lucas HK, Harris FC, Roberts PH, McCall IW, Jackson PC, Powell NL, Staddon GE. Failure of low-dose heparin to prevent deep-vein thrombosis after hip-replacement arthroplasty. The Lancet. 1974 Oct 5;304(7884):795-7.
20. Imperiale TF, Speroff T. A meta-analysis of methods to prevent venous thromboembolism following total hip replacement. JAMA. 1994 Jun 8;271(22):1780-5.
21. Leyvraz PF, Richard J, Bachmann F, van Melle G, Treyvaud JM, Livio JJ, Candardjis G. Adjusted versus fixed-dose subcutaneous heparin in the prevention of deep-vein thrombosis after total hip replacement. New England Journal of Medicine. 1983 Oct 20;309(16):954-8.
22. Francis CW, Marder VJ, Evarts CM, Yaukoolbodi S. Two-step warfarin therapy: prevention of postoperative venous thrombosis without excessive bleeding. JAMA. 1983 Jan 21;249(3):374-8.
23. Francis CW, Pellegrini VD, Marder VJ, Totterman S, Harris CM, Gabriel KR, Azodo MV, Leibert KM. Comparison of warfarin and external pneumatic compression in prevention of venous thrombosis after total hip replacement. JAMA. 1992 Jun 3;267(21):2911-5.
24. Harris WH, Salzman EW, DeSanctis RW, Coutts RD. Prevention of venous thromboembolism following total hip replacement: Warfarin vs dextran 40. JAMA. 1972 Jun 5;220(10):1319-22.
25. Harris WH, Salzman EW, Athanasoulis C, Waltman AC, Baum S, Desanctis RW. Comparison of warfarin, low-molecular-weight dextran, aspirin, and subcutaneous heparin in prevention of venous thromboembolism following total hip replacement. JBJS. 1974 Dec 1;56(8):1552-62.
26. Anderson Jr FA, Hirsh J, White K, Fitzgerald Jr RH, Hip and Knee Registry Investigators. Temporal trends in prevention of venous thromboembolism following primary total hip or knee arthroplasty 1996–2001: findings from the Hip and Knee Registry. Chest. 2003 Dec 1;124(6):349S-56S.
27. O'Donnell M, Linkins LA, Kearon C, Julian J, Hirsh J. Reduction of out-of-hospital symptomatic venous thromboembolism by extended thromboprophylaxis with low-molecular-weight heparin following elective hip arthroplasty: a systematic review. Archives of internal medicine. 2003 Jun 9;163(11):1362-6.
28. Haas S. Prevention of venous thromboembolism: recommendations based on the international consensus and the American College of Chest Physicians sixth consensus conference on antithrombotic therapy. Clinical and Applied Thrombosis/Hemostasis. 2001 Jul;7(3):171-7.
29. Barrack RL. Current guidelines for total joint VTE prophylaxis: dawn of a new day. The Journal of bone and joint surgery. British volume. 2012 Nov;94(11_Supple_A):3-7.
30. Cafri G, Paxton EW, Chen Y, Cheetham CT, Gould MK, Sluggett J, Bini SA, Khatod M. Comparative effectiveness and safety of drug prophylaxis for prevention of venous thromboembolism after total knee arthroplasty. The Journal of arthroplasty. 2017 Nov 1;32(11):3524-8.
31. Markel DC, York S, Liston Jr MJ, Flynn JC, Barnes CL, Davis III CM, AAHKS Research Committee. Venous thromboembolism: management by American association of hip and knee surgeons. The Journal of arthroplasty. 2010 Jan 1;25(1):3-9.
32. Huang HF, Li SS, Yang XT, Xie Q, Tian XB. Rivaroxaban versus enoxaparin for the prevention of venous thromboembolism after total knee arthroplasty: a meta-analysis. Medicine. 2018 Nov;97(48).
33. Lindquist DE, Stewart DW, Brewster A, Waldroup C, Odle BL, Burchette JE, El-Bazouni H. Comparison of postoperative bleeding in total hip and knee arthroplasty patients receiving rivaroxaban, enoxaparin, or aspirin for thromboprophylaxis. Clinical and Applied Thrombosis/Hemostasis. 2018 Nov;24(8):1315-21.
34. Ricket AL, Stewart DW, Wood RC, Cornett L, Odle B, Cluck D, Freshour J, El-Bazouni H. Comparison of postoperative bleeding in total hip and knee arthroplasty patients receiving rivaroxaban or enoxaparin. Annals of Pharmacotherapy. 2016 Apr;50(4):270-5.
35. Huang RC, Parvizi J, Hozack WJ, Chen AF, Austin MS. Aspirin is as effective as and safer than warfarin for patients at higher risk of venous thromboembolism undergoing total joint arthroplasty. The Journal of arthroplasty. 2016 Sep 1;31(9):83-6.
36. Bingham JS, Salib CG, Labban K, Morrison Z, Spangehl MJ. A dedicated anticoagulation clinic does not improve postoperative management of warfarin after total joint arthroplasty. Arthroplasty today. 2018 Sep 1;4(3):340-2.
37. Nam D, Sadhu A, Hirsh J, Keeney JA, Nunley RM, Barrack RL. The use of warfarin for DVT prophylaxis following hip and knee arthroplasty: how often are patients within their target INR range?. The Journal of arthroplasty. 2015 Feb 1;30(2):315-9.
38. Cho SE, Delate T, Witt DM, Clark NP. Thromboembolic and bleeding outcomes of extended duration low-intensity warfarin following elective total knee arthroplasty. Thrombosis research. 2015 Feb 1;135(2):267-71.
39. Hood BR, Cowen ME, Zheng HT, Hughes RE, Singal B, Hallstrom BR. Association of aspirin with prevention of venous thromboembolism in patients after total knee arthroplasty compared with other anticoagulants: a noninferiority analysis. JAMA surgery. 2019 Jan 1;154(1):65-72.
40. Radzak KN, Wages JJ, Hall KE, Nakasone CK. Rate of transfusions after total knee arthroplasty in patients receiving Lovenox or high-dose aspirin. The Journal of arthroplasty. 2016 Nov 1;31(11):2447-51.
41. Agaba P, Kildow BJ, Dhotar H, Seyler TM, Bolognesi M. Comparison of postoperative complications after total hip arthroplasty among patients receiving aspirin, enoxaparin, warfarin, and factor Xa inhibitors. Journal of orthopaedics. 2017 Dec 1;14(4):537-43.
42. Bala A, Murasko MJ, Burk DR, Huddleston 3rd JI, Goodman SB, Maloney WJ, Amanatullah DF. Venous thromboprophylaxis after total hip arthroplasty: aspirin, warfarin, enoxaparin, or factor Xa inhibitors?. HIP International. 2020 Sep;30(5):564-71.
43. Parvizi J, Huang R, Restrepo C, Chen AF, Austin MS, Hozack WJ, Lonner JH. Low-dose aspirin is effective chemoprophylaxis against clinically important venous thromboembolism following total joint arthroplasty: a preliminary analysis. JBJS. 2017 Jan 18;99(2):91-8.
44. Rondon AJ, Shohat N, Tan TL, Goswami K, Huang RC, Parvizi J. The use of aspirin for prophylaxis against venous thromboembolism decreases mortality following primary total joint arthroplasty. JBJS. 2019 Mar 20;101(6):504-13.
45. Hamilton WG, Reeves JD, Fricka KB, Goyal N, Engh GA, Parks NL. Mechanical thromboembolic prophylaxis with risk stratification in total knee arthroplasty. The Journal of arthroplasty. 2015 Jan 1;30(1):43-5.
46. Pavon JM, Adam SS, Razouki ZA, McDuffie JR, Lachiewicz PF, Kosinski AS, Beadles CA, Ortel TL, Nagi A, Williams Jr JW. Effectiveness of intermittent pneumatic compression devices for venous thromboembolism prophylaxis in high-risk surgical patients: a systematic review. The Journal of arthroplasty. 2016 Feb 1;31(2):524-32.
47. Pierce TP, Cherian JJ, Jauregui JJ, Elmallah RK, Lieberman JR, Mont MA. A current review of mechanical compression and its role in venous thromboembolic prophylaxis in total knee and total hip arthroplasty. The Journal of arthroplasty. 2015 Dec 1;30(12):2279-84.
48. Arsoy D, Giori NJ, Woolson ST. Mobile compression reduces bleeding-related readmissions and wound complications after THA and TKA. Clinical orthopaedics and related research. 2018 Feb;476(2):381.
49. Snyder MA, Sympson AN, Scheuerman CM, Gregg JL, Hussain LR. Efficacy in deep vein thrombosis prevention with extended mechanical compression device therapy and prophylactic aspirin following total knee arthroplasty: a randomized control trial. The Journal of arthroplasty. 2017 May 1;32(5):1478-82.