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Venous Thromboembolism in Total Hip Arthroplasty

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Diagnosis and Management of Hip Disease

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Abstract

With the high prevalence of osteoarthritis and the aging population, surgery about the hip is becoming exceedingly more common particularly total hip arthroplasty. Despite advances in surgical techniques and technologies, complications do arise, one of the most common being venous thromboembolism (VTE). Even with mechanical and pharmacologic prophylaxis the incidence of deep vein thrombosis (DVT) is reported to be between 43.7 and 145.0 per 100,000, and the annual incidence of pulmonary embolism (PE) is estimated to range from 20.8 to 65.8 per 100,000. As the signs and symptoms of DVT and pulmonary embolism are frequently nonspecific, various imaging studies have been utilized in assisting with accurate and timely diagnoses. Numerous anticoagulation agents are employed in attempts to prevent symptomatic venous thromboembolic events, including aspirin, low molecular weight heparin (LMWH), fondaparinux, direct factor Xa inhibitors, and direct thrombin inhibitors. While it is widely accepted that patients undergoing total hip arthroplasty should receive prophylaxis, the questions of the ideal agent and duration still remain.

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Abbreviations

AAOS:

American Academy of Orthopaedic Surgeons

ACCP:

American College of Chest Physicians

aPTT:

Activated partial thromboplastin time

CT-PA:

Computed tomography-pulmonary angiogram

DVT:

Deep vein thrombosis

FDA:

Food and Drug Administration

INR:

International normalized ratio

IVC:

Inferior vena cava

LMWH:

Low molecular weight heparin

PE:

Pulmonary embolism

SCIP:

Surgical Care Improvement Project

UFH:

Unfractionated heparin

V/Q scan:

Ventilation-perfusion scan

VTE:

Venous thromboembolism

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Keck Medicine of USC, University of Southern California, 1520 San Pablo Street; Suite 2000, Los Angeles, CA, 90033, USA

    Jay Lieberman MD

  2. Department of Orthopedic Surgery, Keck Medicine of USC, University of Southern California, 1200 N. State Street, GNH 3900, Los Angeles, 90033, CA, USA

    Jessica Bear MD

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Correspondence to Jay Lieberman MD .

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Editors and Affiliations

  1. Department of Orthopedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA

    Roy K. Aaron

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Lieberman, J., Bear, J. (2015). Venous Thromboembolism in Total Hip Arthroplasty. In: Aaron, R. (eds) Diagnosis and Management of Hip Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-19905-4_13

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  • DOI: https://doi.org/10.1007/978-3-319-19905-4_13

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