Life-threatening in the short term and leading to a high level of morbidity in the long term, venous thromboembolism (VTE) is the most fearful complication following lower limb arthroplasty. With advances in surgical procedure, anesthetic management and postoperative convalescence have altered the risks of venous thromboembolism after total joint arthroplasty in the lower extremity. The pathogenesis of VTE is multifactorial and includes the well-known Virchow's triad of hypercoagulability, venous stasis and endothelial damage. Therefore, it is appropriate to use a multimodal approach to thromboprophylaxis. Despite extensive research, the ideal multimodal prophylaxis against venous thrombolism has not been identified. So this article reviews the recent developments in multimodal prophylaxis for thromboembolism after total joint arthroplasty.
Anesthesia, Epidural ; Arthroplasty, Replacement, Hip ; adverse effects ; Arthroplasty, Replacement, Knee ; adverse effects ; Aspirin ; therapeutic use ; Factor Xa Inhibitors ; Heparin, Low-Molecular-Weight ; therapeutic use ; Humans ; Postoperative Complications ; prevention & control ; Venous Thromboembolism ; epidemiology ; prevention & control ; Warfarin ; therapeutic use

OBJECTIVETo evaluate the effect of preoperative donation of autologous bood on venous thromboembolism (VTE) after total hip arthroplasty (THA).

METHODSBetween Jan. 2007 and March. 2010,912 consecutive patients who had THAs performed in Hosptal for Special Surgery were collected, excluded patients with thrombocytopenia or pre-exising bleeding diathesis and patients for whom epidural analgesia was not possible. Among them, there were 428 males and 484 females with an average age of (65.28 +/- 11.90) years (ranged from 24 to 93 years). Among them, 835 cases (91.3%) had osteoarthritis, 32 cases (3.6%) had osteonerrosis, 20 cases (2.3%) had dysplasia, 20 cases (2.2%) had rheumatoid arthritis, and 5 cases (0.6%) had other diagnoses. The surgeries were performed under hypotensive epidural anestheisa (mean arterial pressure between 45 to 55 mm Hg) and through a posterolateral approach, minimizing the duration of femoral vein obstruction and reducing the load of intramedullary content to the venous system by repeated pulsatile lavage and aspiration of the femoral canal. The lower extremity was in the neutral position while working on the acetabulum and flexed and internally rotated while working on the femur. Whenever possible,the lower extremity was extended to a neutral position to restore femoral venous flow. Patients received one bolus of unfractionated intravenous heparin (10 to 15 U/kg), 1 to 2 minutes before femoral canal preparation. All patients were followed up at least 3 months postoperatively. No patient was lost to followed-up.

RESULTSSeven hundreds and fifty-two patients donated autologous blood before THA, 160 did not donate autologoud blood. The incidence of clinical symoptomatic VTE was 1.3% (11/912). Among the 11 patients with clinical symoptomatic VTE, 5 donated blood pre-operation (0.66%, 5/752) and 6 did not donate pre-operation (3.8%, 6/160). The rate of VTE after THA between autologous blood donation and no blood donation was statistically significant (P = 0.021 < 0.05. The incidence of deep vein thrombosis was 0.8%(8/ 912). Three patients had a symptomatic of Pulmonary embolism.

CONCLUSIONA significant decrease in the incidence of VTE is noted in those who had donated blood preoperatively compared with those who had not.

Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; adverse effects ; Blood Transfusion, Autologous ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Venous Thromboembolism ; epidemiology ; prevention & control