Abstract
The selection of a prophylaxis agent is a balance between efficacy and safety. Total knee arthroplasty patients receive DVT prophylaxis because orthopaedic surgeons are concerned about the morbidity and mortality associated with pulmonary embolism. However, at the same time there is great concern about excessive bleeding. The goal is to provide the appropriate anticoagulation to prevent symptomatic pulmonary embolism (PE) and DVT but at the same time avoid over anticoagulation which can be associated with bleeding and other wound problems. Therefore, risk stratification is necessary.
Although risk stratification is the ideal way to determine the appropriate prophylaxis agent to use for a specific patient, there is no validated risk stratification strategy available today. There is general agreement at this time that patients who have had a prior PE or symptomatic DVT are at higher risk for development of a pulmonary embolism. In addition, there is a general belief that patients who have coagulation abnormalities (i.e. Factor V Leiden, Protein C and S deficiency) have an increased risk of developing a pulmonary embolism. Other factors that have been mentioned as associated with PE after total hip arthroplasty include age, female gender, and higher body mass index. The selection of a prophylaxis regimen should be influenced by the ability to mobilise the patient after surgery.
