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The Rationale for the Use of Multimodal Thromboprophylaxis with Limited Anticoagulation in Patients Undergoing Total Joint Replacement: Arguments Against LMWHs Being Still the Gold Standard

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Perioperative Medical Management for Total Joint Arthroplasty

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Abstract

The risk of venous thromboembolism following total hip and knee replacement is well recognized. The administration of UFH, antivitamin K, LMWH, fondaparinux, and acetylsalicylic acid reduces the risk of VTE. New anticoagulants, characterized by predictable anticoagulant activity and no need of monitoring are being introduced. LMWH has been compared with old and new antithrombotic agents in by hundreds of randomized clinical trials and, meta-analysis. Though trials are nonhomogenous, LMWH resulted to be superior to UFH for efficacy and safety and to antivitamin K for efficacy, and not definitely inferior for efficacy when compared to fondaparinux.

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Acknowledgments

This work was partially funded by the generous donation of Mr. Glenn Bergenfield and the Sidney Milton and Leoma Simon Foundation.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Erik Schnaser, Alejandro Gonzalez Della Valle, Nigel Sharrock & Eduardo A. Salvati

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  1. Erik Schnaser
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  2. Alejandro Gonzalez Della Valle
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  4. Eduardo A. Salvati
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Correspondence to Alejandro Gonzalez Della Valle .

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  1. Humanitas Clinical and Research Center, Milan, Italy

    Andrea Baldini

  2. San Donato Hospital, Arezzo, Italy

    Patrizio Caldora

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Schnaser, E., Della Valle, A.G., Sharrock, N., Salvati, E.A. (2015). The Rationale for the Use of Multimodal Thromboprophylaxis with Limited Anticoagulation in Patients Undergoing Total Joint Replacement: Arguments Against LMWHs Being Still the Gold Standard. In: Baldini, A., Caldora, P. (eds) Perioperative Medical Management for Total Joint Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-07203-6_5

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