Establishing Best Practice for Preventing VTE After Orthopaedic Procedures
Cognizant of the limitations of available guidelines on avoiding venous thromboembolism (VTE) after orthopaedic surgery,  Javad Parvizi, MD, led a panel of experts from various medical specialties in a year-long process of developing practical recommendations for preventing this potentially lethal consequence of many orthopaedic procedures.
According to Dr. Parvizi, the guidance in the newly published International Consensus Statement (ICS) on VTE will improve patient care by reducing mortality, complications, and subsequent episode of care costs.
“The ICS revealed [that] there is little to no best practice evidence related to VTE following the majority of orthopedic procedures, and the nature of these surgical procedures has changed over the years – now with an emphasis on early mobilization of the patients and less-invasive surgical and anesthesia techniques,” he said.
With a shared mission to standardize treatment guidelines and decrease the occurrence VTE worldwide, 600 experts from various specialties – including anesthesia, cardiology, hematology, internal medicine, and orthopaedics – met to review the published literature related to VTE and orthopaedics and then develop the recommendations for VTE prophylaxis in orthopaedics.
The recommendations, which went through multiple rounds of peer review, were driven by 200 unanswered questions related to the various subspecialties in orthopaedics, and they have been published together as an ICS in The Journal of Bone and Joint Surgery under these headings:
- Recommendations from the ICM-VTE: General
- Recommendations from the ICM-VTE:: Foot & Ankle
- Recommendations from the ICM-VTE: Hand & Wrist
- Recommendations from the ICM-VTE: Hip & Knee
- Recommendations from the ICM-VTE: Oncology
- Recommendations from the ICM-VTE: Pediatric
- Recommendations from the ICM-VTE: Shoulder & Elbow
- Recommendations from the ICM-VTE: Sports
- Recommendations from the ICM-VTE: Trauma
- Recommendations from the ICM-VTE: Spine
Highlights from the recommendations include the following:
- Mechanical compressive devices can be used routinely in patients undergoing total hip arthroplasty or total knee arthroplasty as VTE prophylaxis.
- Aspirin and intermittent pneumatic compression devices may be adequate following the majority of surgical procedures.
- Development of VTE is influenced by genetic and other patient-specific predispositions. Recognizing these factors may help to tailor VTE prophylaxis accordingly.
- The industry currently lacks a validated, appropriate risk stratification system for VTE or bleeding. The medical community desperately needs those measures and stratification systems.
International Consensus Meeting on Venous Thromboembolism. Journal of Bone & Joint Surgery, March 16, 2022, Volume 104, Supplement 1. Available at https://journals.lww.com/jbjsjournal/toc/2022/03161; accessed April 6, 2022.
- Swiontkowski M, Parvizi J. International Consensus Meeting on Venous Thromboembolism. J Bone Joint Surg Am. 2022 Mar 16;104(Suppl 1):1-3. doi: 10.2106/JBJS.22.00038.