Multimodal Venous Thromboembolism Prophylaxis with Preoperative Thrombophilia Screening Examinations for Total Hip and Knee Arthroplasties


  • Yasushi Oshima
  • Joseph Fetto



total hip and knee arthroplasties, multimodal venous thromboembolism prophylaxis, thrombophilia screening examinations, factor VIII, prothrombin gene mutation


Objective: To evaluate the efficacy of a multimodal venous thromboembolism (VTE) prophylaxis including preoperative thrombophilia screening for total hip and knee arthroplasties (THAs and TKAs) and to consider the possibility of utilizing thrombophilic blood markers for preoperative  identification of patients with high risk for VTE..

Method: The physical evaluation, involving the medical history of previous VTE, recent malignancy, and preoperative prolonged immobility status, and the existence of deep venous thrombosis  (DVT) detected by duplex venous ultrasonography were assessed. Then, the patients with high risk of VTE were offered an inferior vena cava (IVC) filter preoperatively. The laboratory examination of complete blood count and standard biochemistry with factor VIII, activated protein C resistance (APCR), and prothrombin gene mutation were also measured. The operations were performed under regional anesthesia in most cases, and with venous foot pump (VFP), and early mobilization and aspirin (325 mg) daily were applied postoperatively.

Results: IVC filters were placed in 6, and acute DVT was detected in 5 of the total 99 cases. However, there was no critical bleeding or fatal VTE. In the blood markers, prothrombin mutation and factor VIII seemed to have a relation to DVT.

Conclusion: The efficacy of our multimodal protocol was confirmed. Further research is necessary to apply factor VIII and prothrombin gene mutation as thrombophilic blood markers.

Author Biography

Yasushi Oshima

MD, PhD, Orthopaedic Surgeon


Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am. 2004 May;86-A(5):963-74.

Kurtz SM, Ong KL, Lau E, Bozic KJ. Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021. J Bone Joint Surg Am. 2014 Apr 16;96(8):624-30.

Lopez JA, Chen J. Pathophysiology of venous thrombosis. Thromb Res 2009, 123(Suppl 4):S30–34.

Vulcano E, Gesell M, Esposito A, Ma Y, Memtsoudis SG, Gonzalez Della Valle A. Aspirin for elective hip and knee arthroplasty: a multimodal thromboprophylaxis protocol. Int Orthop. 2012 Oct;36(10):1995-2002.

Yassin M, Mitchell C, Diab M, Senior C. The necessity of pharmacological prophylaxis against venous thromboembolism in major joint arthroplasty. Int Orthop. 2014 May;38(5):1073-5.

Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, Ray JG. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004 Sep;126(3 Suppl):338S-400S.

Drescher FS, Sirovich BE, Lee A, Morrison DH, Chiang WH, Larson RJ. Aspirin versus anticoagulation for prevention of venous thromboembolism major lower extremity orthopedic surgery: a systematic review and meta-analysis. J Hosp Med. 2014 Sep;9(9):579-85.

Lindblad B, Eriksson A, Bergqvist D. Autopsy-verified pulmonary embolism in a surgical department: analysis of the period from 1951 to 1988. Br J Surg. 1991 Jul;78(7):849-52.

Hamilton WG, Reeves JD, Fricka KB, Goyal N, Engh GA, Parks NL. Mechanical Thromboembolic Prophylaxis With Risk Stratification in Total Knee Arthroplasty. J Arthroplasty. 2015 Jan;30(1):43-5.

Eikelboom JW, Karthikeyan G, Fagel N, Hirsh J. American Association of Orthopedic Surgeons and American College of Chest Physicians guidelines for venous thromboembolism prevention in hip and knee arthroplasty differ: what are the implications for clinicians and patients? Chest. 2009 Feb;135(2):513-20.

Leali A, Fetto FJ, Moroz A. Prevention of thromboembolic disease after non-cemented hip arthroplasty. A multimodal approach. Acta Orthop Belg. 2002 Apr;68(2):128-34.

Ragucci MV, Leali A, Moroz A, Fetto FJ. Comprehensive deep venous thrombosis prevention strategy after total-knee arthroplasty. Am J Phys Med Rehabil. 2003 Mar;82(3):164-8.

Budhiparama NC, Abdel MP, Ifran NN, Parratte S. Venous Thromboembolism (VTE) Prophylaxis for Hip and Knee Arthroplasty: Changing Trends. Curr Rev Musculoskelet Med. 2014 Jun;7(2):108-16.

Rosendaal FR. Venous thrombosis: the role of genes, environment, and behavior. Hematology Am Soc Hematol Educ Program. 2005:1-12.

Lotke PA, Lonner JH. The benefit of aspirin chemoprophylaxis for thromboembolism after total knee arthroplasty. Clin Orthop Relat Res. 2006 Nov;452:175-80.

Gesell MW, González Della Valle A, Bartolomé García S, Memtsoudis SG, Ma Y, Haas SB, Salvati EA. Safety and efficacy of multimodal thromboprophylaxis following total knee arthroplasty: a comparative study of preferential aspirin vs. routine coumadin chemoprophylaxis.

J Arthroplasty. 2013 Apr;28(4):575-9.

Stewart DW, Freshour JE. Aspirin for the prophylaxis of venous thromboembolic events in orthopedic surgery patients: a comparison of the AAOS and ACCP guidelines with review of the evidence. Ann Pharmacother. 2013 Jan;47(1):63-74.

Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, Sage D, Futter M, Saville G, Clark T, MacMahon S. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000 Dec 16;321(7275):1493-1505.

Salvati EA, Sharrock NE, Westrich G, et al. The 2007 ABJS Nicolas Andry Award: three decades of clinical, basic, and applied research on thromboembolic disease after THA: rationale and clinical results of a multimodal prophylaxis protocol. Clin Orthop Relat Res 2007;459:246.

White RH, Henderson MC. Risk factors for venous thromboembolism after total hip and knee replacement surgery. Curr Opin Pulm Med. 2002 Sep;8(5):365-71.

Friedman RJ, Hess S, Berkowitz SD, Homering M. Complication rates after hip or knee arthroplasty in morbidly obese patients. Clin Orthop Relat Res. 2013 Oct;471(10):3358-66.

Jenkins PV, Rawley O, Smith OP, O'Donnell JS. Elevated factor VIII levels and risk of venous thrombosis. Br J Haematol. 2012 Jun;157(6):653-63.

Pabinger I, Ay C. Biomarkers and venous thromboembolism. Arterioscler Thromb Vasc Biol. 2009 Mar;29(3):332-6.

WÃ¥hlander K, Larson G, Lindahl TL, Andersson C, Frison L, Gustafsson D, Bylock A, Eriksson BI. Factor V Leiden (G1691A) and prothrombin gene G20210A mutations as potential risk factors for venous thromboembolism after total hip or total knee replacement surgery. Thromb Haemost. 2002 Apr;87(4):580-5.

Ho WK, Hankey GJ, Eikelboom JW. Should adult patients be routinely tested for heritable thrombophilia after an episode of venous thromboembolism? Med J Aust. 2011 Aug 1;195(3):139-42.

Hornsby LB, Armstrong EM, Bellone JM, Treadway S, Phillippe HM. Thrombophilia Screening. J Pharm Pract. 2014 Apr 16;27(3):253-259.




How to Cite

Oshima, Y., & Fetto, J. (2015). Multimodal Venous Thromboembolism Prophylaxis with Preoperative Thrombophilia Screening Examinations for Total Hip and Knee Arthroplasties. Reconstructive Review, 5(4).



Original Article