Multimodal Venous Thromboembolism Prophylaxis with Preoperative Thrombophilia Screening Examinations for Total Hip and Knee Arthroplasties

Abstract

Objective: To evaluate the efficacy of a multimodal venous thromboembolism (VTE) prophylaxis including preoperative thrombophilia screening for total hip and knee arthroplasties (THAs and TKAs) and to consider the possibility of utilizing thrombophilic blood markers for preoperative  identification of patients with high risk for VTE.. Method: The physical evaluation, involving the medical history of previous VTE, recent malignancy, and preoperative prolonged immobility status, and the existence of deep venous thrombosis  (DVT) detected by duplex venous ultrasonography were assessed. Then, the patients with high risk of VTE were offered an inferior vena cava (IVC) filter preoperatively. The laboratory examination of complete blood count and standard biochemistry with factor VIII, activated protein C resistance (APCR), and prothrombin gene mutation were also measured. The operations were performed under regional anesthesia in most cases, and with venous foot pump (VFP), and early mobilization and aspirin (325 mg) daily were applied postoperatively. Results: IVC filters were placed in 6, and acute DVT was detected in 5 of the total 99 cases. However, there was no critical bleeding or fatal VTE. In the blood markers, prothrombin mutation and factor VIII seemed to have a relation to DVT. Conclusion: The efficacy of our multimodal protocol was confirmed. Further research is necessary to apply factor VIII and prothrombin gene mutation as thrombophilic blood markers.