Advancements in venous thromboembolism prophylaxis strategies for total hip arthroplasty: a comprehensive narrative review

Abstract

Worldwide, total hip arthroplasty (THA) is a widely performed procedure. However, it is associated a significant risk of venous thromboembolism (VTE), a serious and potentially lifethreatening complication. As a result, VTE prophylaxis has been a focal point of ongoing clinical research and discussion. Despite extensive evaluation, there is still no definitive consensus on the optimal strategy for preventing VTE in patients undergoing THA. The absence of a clear gold standard highlights the complexity of balancing the benefits of thromboprophylaxis with the risks of bleeding and other wound complications. This review aims to address this gap by providing a thorough examination of current literature on VTE prophylaxis in the context of THA.

To explore the most effective and safest strategies for VTE prevention, we conducted a narrative review, analysing studies and guidelines from major medical databases. Our review focuses on key aspects of VTE prophylaxis, including patient-specific risk factors, diagnostic challenges, treatment-related complications, and recent advancements in both pharmacological and mechanical prevention strategies. We evaluated anticoagulants such as low molecular weight heparins, direct oral anticoagulants, and aspirin, alongside mechanical methods such as pneumatic compression devices and early mobilisation. Each prophylactic method was assessed for its effectiveness in reducing VTE incidence as well as its associated risks, including bleeding, wound complications and patient compliance.

Our synthesis of the available evidence highlights both established practices and emerging controversies in the field, offering a comprehensive understanding of the various options available to clinicians. Given the individualised nature of VTE risk in THA patients, this review emphasises the importance of tailored prophylaxis strategies, accounting for patient comorbidities, surgical factors and personal preferences. The findings of this review underscore the necessity for ongoing research and interdisciplinary collaboration to refine and optimise VTE prevention in the evolving landscape of THA. As the field progresses, it is crucial that clinicians remain updated on new evidence to make informed, patient-centred decisions that enhance safety and outcomes in THA.

Level of evidence: 5