Utilization Patterns, Efficacy, and Complications of Venous Thromboembolism Prophylaxis Strategies in Primary Hip and Knee Arthroplasty as Reported by American Board of Orthopaedic Surgery Part II Candidates

Abstract Background Many strategies for venous thromboembolism (VTE) prophylaxis following hip and knee arthroplasty exist, with extensive controversy regarding the optimum strategy to minimize risk of VTE and bleeding complications. Data from the American Board of Orthopaedic Surgery (ABOS) Part II (oral) Examination case list database was analyzed to determine efficacy, complication rates and prescribing patterns for different prophylactic strategies. Methods The ABOS case database was queried utilizing Current Procedural Terminology (CPT) codes 27447 and 27130 for primary total knee and hip arthroplasty, respectively. Geographic region, patient age, gender, DVT prophylaxis strategy and complications were obtained. Less aggressive prophylaxis patterns were considered if only aspirin and/or sequential compression devises (SCDs) were utilized. More aggressive VTE prophylaxis patterns were considered if any of low molecular weight heparin (enoxaparin), warfarin, rivaroxaban, fondaparinux or other strategies were used. Results 22,072 cases of primary joint arthroplasty were analyzed from 2014-2016. The national rate of less aggressive VTE prophylaxis strategies was 45.4% while more aggressive strategies were used in 54.6% of patients. Significant regional differences in prophylactic strategy patterns exist between the 6 regions. The predominant less aggressive prophylaxis pattern was aspirin with SCDs at 84.8% with 14.8% receiving aspirin alone. Use of less aggressive prophylaxis strategy was significantly associated with patients having no complications (95.5% vs 93.0%). Use of more aggressive prophylaxis patterns was associated with higher likelihood of mild thrombotic (0.9% vs 0.2%), mild bleeding (1.3% vs 0.4%), moderate thrombotic (1.2% vs 0.4%), moderate bleeding (2.7% vs 2.1%), severe thrombotic (0.1% vs 0.0%), and severe bleeding events (1.2% vs 0.9%), infections (1.9% vs 1.3%) and death within 90 days (0.7% vs 0.3%). Similar results were found in subgroup analysis of THA and TKA patients. Conclusion It was not possible to ascertain the individual rationale for use of more aggressive VTE prophylaxis strategies; however, more aggressive strategies were associated with higher rates of bleeding and thrombotic complications. Less aggressive strategies were not associated with a higher rate of thrombosis. Level of Evidence Therapeutic Level III. Disclaimer All views expressed in the study are the sole views of the authors and do not represent the views of the American Board of Orthopaedic Surgery.