Patients who have undergone
total hip arthroplasty are at risk for venous thromboembolic disease, including
deep venous thrombosis,
pulmonary embolism, and
postphlebitic syndrome. Although the number of annual
total hip arthroplasties in the United States has steadily risen in the past decade, the rate of venous thromboembolic disease within that patient group has declined as a result of advances in surgical and
postoperative procedures, including prompt mobilization and safety and efficacy of thromboprophylactic alternatives. This paper reviews the therapeutic options for
deep venous thrombosis prophylaxis following
total hip arthroplasty, with an emphasis on recommendations of the Sixth American College of Chest Physicians Consensus Conference on Antithrombotic
Therapy. The implications of recent randomized clinical trials on care provided by physiatrists in the rehabilitation facility setting are also discussed. The low-molecular-weight heparins have become widely accepted alternatives to
aspirin,
heparin, and
warfarin as results from randomized clinical trials have proved their superior safety and efficacy in the postoperative period. Prolonged prophylaxis up to 30 to 35 days postoperatively in
total hip arthroplasty may offer additional protection against
venous thrombosis. Therefore, to prescribe optimal thromboprophylactic regimens following
total hip arthroplasty, physicians require an understanding of the current recommendations of the Sixth American College of Chest Physicians Consensus Conference on Antithrombotic
Therapy and the implications of recently concluded clinical trials.