Review Question - QID 3591

AAOS Clinical Guideline on Preventing PE in Arthroplasty Patients includes aspirin as a thromboembolism prevention modality. Therefore the statement "aspirin is not approved as a preventative medication for VTED in low risk patients" is false.

Mont et al discuss the 10 recommendation in the AAOS clinical practice guideline, Preventing Venous Thromboembolic Disease in Patients Undergoing Elective Hip and Knee Arthroplasty. The orthobullets interpretation of their recommendation is:

1. Post-operative screening ultrasonography is not indicated. (ANSWER 4)
2. Previous venous thromboembolism is the only risk factor for thromboembolism clearly supported by evidence.
3. Known bleeding disorders and active liver disease are the only risk factor for bleeding clearly supported by evidence.
4. Patients should discontinue antiplatelet agents (e.g., aspirin, clopidogrel) preop. (ANSWER 1)
5. All patients should get pharmacologic agents and/or mechanical compressive devices for prophylaxis.
6. Patients with previous venous thromboembolism should receive pharmacologic prophylaxis AND mechanical compressive.
7. Patient with known bleeding disorder and/or active liver disease should use mechanical compressive prophylaxis. (ANSWER 5)
8. Patient should be mobilized early.
9. Intrathecal, epidural, and spinal anesthesia should be used. (ANSWER 3)
10. IVC filters are not clearly supported by the literature in patients who also have a contraindication to chemoprophylaxis and/or known residual venous thromboembolic disease

Eikelboom et al discussed the differences between the AAOS recommendations and those of the American College of Chest Physicians. They identify weakness in the methodology of the AAOS recomendations and "recommend the ACCP guidelines because the methodology is explicit and rigorous and the treatment recommendations reflect all of the evidence from the randomized trials."