Does the Ideal VTE Prophylaxis Exist?

    The ideal agent for prophylaxis of venous thromboembolism (VTE) following total hip and total arthroplasty does not exist, but according to Richard J. Friedman, MD, FRCSC, we’re getting closer.

    Dr. Friedman, Clinical Professor of Orthopaedic Surgery at the Medical University of South Carolina in Charleston, said the ideal agent should be:

    • Efficacious
    • Inexpensive
    • Easy to administer and monitor
    • No complications or side effects

    With hospital stays for major joint arthroplasty down to as little as 2 days, administration of prophylactic agents for VTE is now occurring on an outpatient basis – which makes convenient administration and monitoring even more important.

    Previously, orthopaedic surgeons were limited to intravenous or subcutaneous medications. Warfarin is available in an oral form, but it has a narrow therapeutic range (efficacy and safety) that requires frequent monitoring and dosing adjustments. The new factor Xa oral agents have fixed dosages, do not require laboratory monitoring, and have a rapid onset/offset, Dr. Friedman said. The only factor Xa agent approved in the U.S. for VTE prevention is rivaroxaban.

    Dr. Friedman’s presentation on VTE prophylaxis from ICJR’s annual Winter Hip & Knee Course can be found here.