The Future of Thromboembolic Prophylaxis

For the last 30 years, surgeons have balanced the need for deep-venous thrombosis (DVT) prophylaxis with the need to avoid complications following total joint arthroplasty. Debate continues regarding prophylaxis against venous thromboembolism (VTE). Despite established guidelines and continued research, no consensus exist as to what agent affords the best balance between reducing DVT rates and minimizing the incidence of bleeding and wound complications. New oral anticoagulants offer the ease of oral administration and excellent efficacy, but remain unavailable in the United States and may lead to increased bleeding. New portable pneumatic compression devices look promising. They allow outpatient use and may improve compliance, but their exact role in the future of DVT prophylaxis remains undetermined.