Management of Venous Thromboembolism After Hip and Knee Arthroplasty.

Journal of orthopaedics and sports medicine Pub Date : 2025-01-01 Epub Date: 2025-07-07 DOI:10.26502/josm.511500210
Alexander Postajian, Edgmin Rostomian, Alexander Abdou, Vedi Hatamian, Samson Keshishian, Devendra K Agrawal
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Abstract

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.

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髋关节和膝关节置换术后静脉血栓栓塞的处理。
静脉血栓栓塞(VTE),一个包含深静脉血栓形成(DVT)和肺栓塞(PE)的术语,仍然是全髋关节置换术(THA)和全膝关节置换术(TKA)后死亡的主要原因。随着全球全关节置换术的需求和频率的增加,优化血栓预防,或手术后静脉血栓栓塞的预防变得越来越重要。本文综述了目前关于全髋关节置换术和全髋关节置换术患者静脉血栓栓塞的危险因素、检测和预防的文献。它比较了包括阿司匹林、低分子肝素、利伐沙班、阿哌沙班和华法林在内的最常见药物干预的疗效和安全性。机械方法,如气动压缩装置,以及术中注意事项,如麻醉方式,手术时间,止血带时间,也进行了讨论。此外,本综述探讨了最近的外科进展,包括微创入路和机器人辅助THA和TKA。尽管取得了进步和广泛的研究,最佳的血栓预防方案仍然存在争议,这突出了个体化,以患者为中心的血栓预防方法的需要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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