What VTE rate is expected after THA and TKA without prophylaxis?

Without prophylaxis: DVT in 40-60% TKA, 40-50% THA; symptomatic PE in 1-3%, fatal PE in 0.1-0.2%. With optimal prophylaxis: symptomatic VTE <1%, fatal PE <0.05%. Extended prophylaxis (35 days) for THA, 10-14 days for TKA (ACCP).

What DOACs are approved for arthroplasty prophylaxis?

Rivaroxaban (Xarelto) 10 mg daily: 35 days THA, 12 days TKA. Apixaban (Eliquis) 2.5 mg BID: 35 days THA, 12 days TKA. Both are non-inferior to enoxaparin with similar or reduced major bleeding. DOACs are preferred by most modern guidelines.

What is the role of mechanical prophylaxis in orthopedic VTE prevention?

Intermittent pneumatic compression (IPC) devices reduce DVT by 50-60% but must be worn continuously to be effective. Recommended for all arthroplasty patients. IPC alone may be sufficient for low-risk patients or those with bleeding contraindications to pharmacological prophylaxis.

Orthopedic VTE Risk and Prophylaxis Selection (ACCP/AAOS)

Calculate VTE risk and select pharmacological prophylaxis for orthopedic surgery (THA, TKA, hip fracture, spine). ACCP 2012 recommends extended-duration LMWH, warfarin, or DOACs for 10-35 days post-arthroplasty. Balances VTE risk against surgical bleeding risk.

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