Letters To The Editor

VTE prevention in major orthopedic surgery

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Editor's Note: This letter concerns an article in a Cleveland Clinic Journal of Medicine supplement (Preventing Venous Thromboembolism Throughout the Continuum of Care) distributed to only a portion of the Journal's regular readership, owing to the terms of the grant supporting the supplement.

To the Editor: I must strongly disagree with Deitelzweig and colleagues’ recommendations against the use of aspirin for thromboprophylaxis in elective joint replacement surgery.1 The references cited2–5 are outdated. In the last few years, in patients undergoing minimally invasive hip replacement (done either posterolaterally or via an anterior approach with epidural anesthesia), early ambulation and thromboprophylaxis with compression boots and enteric-coated aspirin (or alternative antiplatelet agents in patients allergic to aspirin) has been associated with a lower incidence of deep vein thrombosis (DVT) and postoperative bleeding than either enoxaparin or fondaparinux.6–9

Our experience in Los Angeles under the direction of Dr. Lawrence Dorr, past president of the Hip Society, is also instructive: minimally invasive hip replacement performed via a posterior approach with a 2- to 3-day length of stay and with the use of multimodal thromboprophylaxis including aspirin (or an alternate antiplatelet) has resulted in a low incidence of proximal DVT and no deaths from pulmonary embolism.10 Our experience with total knee replacement is similar but has included a slightly higher rate of DVT in patients older than 75 years of age.10

The American Academy of Orthopaedic Surgeons has clearly supported the use of aspirin as an effective modality for DVT prophylaxis.11 We are patiently awaiting the newest recommendations from the American College of Chest Physicians, which I believe should incorporate aspirin in DVT prophylaxis and thus get medical physicians on the same page as orthopedic surgeons.

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VTE prevention in major orthopedic surgery

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