Thromboembolism Prophylaxis in Hip Arthroplasty: Routine and High Risk Patients

This study's purpose was to present the use of a risk stratification protocol in which “routine” risk patients receive a mobile compression device with aspirin and “high” risk patients receive warfarin for thromboprophylaxis after hip arthroplasty. 1859 hip arthroplasty patients were prospectively enrolled (1402 routine risk - 75.4%, 457 high risk - 24.6%). The cumulative rate of venous thromboembolism events was 0.5% in the routine versus 0.5% in the high-risk cohort within 6 weeks postoperatively (P = 1.00). Patients in the routine risk cohort had a lower rate of major bleeding (0.5% versus 2.0%, P = 0.006) and wound complications (0.2% versus 1.2%, P = 0.01). Use of our risk stratification protocol allowed the avoidance of more aggressive anticoagulation in 75% of patients while achieving a low overall incidence of symptomatic VTE.