Postajian Alexander, Rostomian Edgmin, Abdou Alexander, Hatamian Vedi, Keshishian Samson, Agrawal Devendra K
Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, California, 91766, USA.
J Orthop Sports Med. 2025;7(3):311-327. doi: 10.26502/josm.511500210. Epub 2025 Jul 7.
Venous thromboembolism (VTE), a term encompassing both deep vein thrombosis (DVT) and pulmonary embolism (PE), remains a leading cause of mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Optimizing thromboprophylaxis, or the prevention of VTE after surgery, is becoming increasingly critical as the demand and frequency of total joint arthroplasty rises globally. This review covers the current literature on the risk factors, detection, and prevention of VTE in patients undergoing THA and TKA. It compares the efficacy and safety profiles of the most common pharmacological interventions including aspirin, low molecular weight heparin, rivaroxaban, apixaban, and warfarin. Mechanical methods, such as pneumatic compression devices, as well as intraoperative considerations, such as anesthesia modality, operative time, and tourniquet time, are also discussed. Furthermore, this review explores recent surgical advancements including minimally invasive approaches and robotic-assisted THA and TKA. Despite advancements and extensive research, the optimal thromboprophylaxis regimen remains debated, which highlights the need for individualized, patient-centered approaches to thromboprophylaxis.
静脉血栓栓塞症（VTE），这一术语涵盖了深静脉血栓形成（DVT）和肺栓塞（PE），仍然是全髋关节置换术（THA）和全膝关节置换术（TKA）后导致死亡的主要原因。随着全球全关节置换术的需求和频率不断上升，优化血栓预防，即预防术后VTE，变得越来越关键。这篇综述涵盖了目前关于接受THA和TKA患者VTE的风险因素、检测和预防的文献。它比较了最常见药物干预措施（包括阿司匹林、低分子量肝素、利伐沙班、阿哌沙班和华法林）的疗效和安全性。还讨论了机械方法，如气动压缩装置，以及术中的考虑因素，如麻醉方式、手术时间和止血带使用时间。此外，本综述探讨了近期的手术进展，包括微创方法以及机器人辅助的THA和TKA。尽管有进展和广泛的研究，但最佳的血栓预防方案仍存在争议，这凸显了采用个性化、以患者为中心的血栓预防方法的必要性。
