Risk-Stratified Venous Thromboembolism Prophylaxis Following Total Joint Arthroplasty: Aspirin and Sequential Pneumatic Compression Devices versus Aggressive Chemoprophylaxis

Background: Venous thromboembolism (VTE) is a major concern following total joint arthroplasty (TJA). We evaluated a risk-stratified prophylaxis protocol for patients undergoing TJA.

Methods: A total of 2,611 TJA patients were retrospectively studied. Patients treated with an aggressive VTE chemoprophylaxis protocol were compared to patients treated with a risk-stratified protocol utilizing aspirin and sequential pneumatic compression devices (SPCDs) for standard risk patients and targeted anticoagulation for high risk patients.

Results: We found equivalence in terms of VTE prevention between the two cohorts. There was a decrease in adverse events and readmissions among the risk-stratified cohort, although this did not reach statistical significance. A statistically significant reduction in costs (p<0.001) was experienced with the use of aspirin/SPCDs compared to aggressive anticoagulation agents within the risk-stratified cohort.

Conclusion: The use of aspirin/SPCDs in a risk-stratified TJA population is a safe and cost effective method of VTE prophylaxis.

Keywords: venous thromboembolism; pulmonary embolism; deep venous thrombosis; risk stratification; cost