What are the latest trends in thromboprophylaxis following total hip or knee replacement?
Seance of wednesday 19 november 2025 (Communications libres)
DOI number : 10.26299/embs-ap93/emem.2025.47.02
Abstract
Total hip replacement (THR) or total knee replacement (TKR) surgery is a frequent source of thromboembolic complications if thromboembolic prophylaxis is not prescribed. French recommendations exist and were updated in 2024. These have changed little since the previous recommendations in 2011. The recommended duration of treatment with direct oral anticoagulants (DOACs) is now 35 days following total hip replacement (THR) and 14 days following total knee replacement (TKR). An alternative is to prescribe an anticoagulant for five days, followed by acetylsalicylic acid (ASA). Modern enhanced recovery pathways and outpatient hospitalisation have been introduced. However, there have been few changes to thromboprophylaxis regimens.
These new practices have had a significant impact, reducing the frequency of thromboembolic events (TEEs) to less than 1 per cent and eliminating deaths related to these TEEs. The risk of major haemorrhage is significant (0.7 to 2 per cent), depending on the molecules used. Publications rarely report minor bleeding. However, minor bleeding can result in a number of issues, including haemarthrosis, pain, joint stiffness, scar oozing and infections.
Numerous recent randomised controlled studies indicate that ASA is not inferior to standard anticoagulants for the prevention of VTE, with no difference in bleeding rates. However, the benefit to society is considerable as the costs are very low.
It is desired by the Hip and Knee Society that ASA be allowed for thromboprophylaxis from the day of surgery, as is widely prescribed in the United States and the United Kingdom.
These new practices have had a significant impact, reducing the frequency of thromboembolic events (TEEs) to less than 1 per cent and eliminating deaths related to these TEEs. The risk of major haemorrhage is significant (0.7 to 2 per cent), depending on the molecules used. Publications rarely report minor bleeding. However, minor bleeding can result in a number of issues, including haemarthrosis, pain, joint stiffness, scar oozing and infections.
Numerous recent randomised controlled studies indicate that ASA is not inferior to standard anticoagulants for the prevention of VTE, with no difference in bleeding rates. However, the benefit to society is considerable as the costs are very low.
It is desired by the Hip and Knee Society that ASA be allowed for thromboprophylaxis from the day of surgery, as is widely prescribed in the United States and the United Kingdom.