March 24, 2022 – The Journal of Bone and Joint Surgery published an International Consensus Statement (ICS) with recommendations on Venous Thromboembolism (VTE) – the result of a year-long process supported by a grant from Cardinal Health and led by Dr. Javad Parvizi, MD, orthopedic surgeon and director of Clinical Research at the Rothman Orthopaedic Institute.
According to the National Institute of Health, VTE – otherwise known as blood clots in the veins – is “a common complication during and after hospitalization for medical and surgical patients. More than half of all hospitalized patients are at risk for VTE.” VTE presents a serious, but often preventable problem for patients in the hospital. VTE associated with hospitalization was the leading cause of disability adjusted life-years lost in low-income and middle-income countries, and the second most common cause in high-income countries.1
With a shared mission to standardize treatment guidelines and decrease the occurrence of this complication worldwide, 600 experts from various specialties, including anesthesia, cardiology, hematology, internal medicine, and orthopedics, representing 68 countries and 135 international societies, met to review all published literature related to VTE and orthopedics, and develop the recommendations for VTE prophylaxis in orthopedic surgery; these recommendations were published together as an ICS.
Many organizations globally, including the American Academy of Orthopedic Surgeons and the American College of Chest Physicians, have created guidelines related to the issue of VTE in orthopedics. However, this is the first time an ICS toward prevention of VTE in orthopedic procedures has been published.
The findings produced by this initiative were driven by 200 questions, or subject matters, which included various surgical subspecialities in orthopedics. Important clinical information that will improve patient care were published in these various categories. Key highlights include:
- Mechanical compressive devices can be used routinely in patients undergoing total hip arthroplasty or total knee arthroplasty as VTE prophylaxis.
- For the majority of surgical procedures, it appears that aspirin and intermittent pneumatic compression devices, may be adequate.
- Development of VTE is influenced by genetic and other patient-specific predispositions. Recognizing these factors may help tailor the VTE prophylaxis accordingly.
- Currently, the industry lacks a validated and appropriate risk stratification system for VTE or bleeding; the medical community desperately needs those measures and stratification systems.