Deep Vein Thrombosis

THA (total hip arthroplasty) is considered one of the orthopedic surgeries with the highest risk of VTE, and measures to prevent VTE, especially to avoid fatal PTE, are essential. The American College of Chest Physicians (ACCP) 8th edition recommends the routine use of LMWH, fondaparinux, or warfarin (grade 1A) until the bleeding risk is reduced in patients at high risk for bleeding. Intermittent pneumatic compression device (IPCD) should be used for patients with high bleeding risk until the bleeding risk is reduced, after which the patient should be switched to or added anticoagulants [26]. In contrast, the 9th edition, revised in 2017, includes the use of low molecular weight heparin (LMWH), fondaparinux, apixaban, dabigatran, and warfarin. dabigatran, reversaloxaban, unfractionated heparin (LDUH), warfarin, or aspirin, but the level of evidence decreased and became grade 1B [7]. Furthermore, for patients at high risk of bleeding, the use of IPCD is recommended instead of anticoagulants. This is because there is insufficient evidence for prophylactic administration of anticoagulants when the endpoint is the difference in the frequency of symptomatic and fatal PTE and symptomatic DVT. On the other hand, the mortality rate from symptomatic PTE has been gradually decreasing since 2008, when direct oral anticoagulant (DOAC) was introduced in Japan in the JSA-PTE study, and it is possible that newer anticoagulants contribute to the decrease in mortality [31]. Ideally, the timing, volume, and duration of anticoagulant initiation should be tailored to each patient based on individual VTE/bleeding risk assessment and with sufficient informed consent. VTE prophylaxis in THA patients is not a uniform approach, and the most appropriate prophylaxis should be selected for each individual patient. The continuous research and updates on VTE are needed in the future, because the incidence of perioperative fatal PTE has not yet been eliminated, and the risks and prophylaxis may change as the surgical technique and patients are changed.