Should prophylaxis of venous thromboembolism in Asian patients undergoing knee and hip arthroplasty and hip fracture surgery be an issue?

Postoperative venous thromboembolism (VTE) is a significant cause of morbidity and mortality in patients undergoing knee and hip arthroplasty and hip fracture surgery, while VTE is considered potentially preventable with several modalities of prophylactic management [1].

The VTE prevention guidelines by the American Academy of Orthopedic Surgeons (AAOS) or the American College of Chest Physicians (AACP) have been implemented in most countries in Asia [2, 3]. However, there are some concerning issues and complications related to VTE prophylaxis in major joint replacement and hip fracture surgeries according to these guidelines, due to differences in the healthcare systems and various cultural aspects [4-6].

Among orthopedic surgeons who practice in the Asia-Pacific (AP) region, some alternative options for VTE prevention in hip and knee arthroplasty and hip fracture surgery are believed to be necessary [7-10]. These Asian-specific guideline/consensus statements are expected to provide better patient outcomes and compliance. Therefore, in a 1-year period, The Thai Hip and Knee Society (THKS) has initiated an AP consensus agreement on VTE prophylaxis in knee and hip arthroplasty and hip fracture surgery in Asian patients. Ninety-three orthopedic experts from the AP region volunteered to join the consensus using an overall five-round modified Delphi method. According to the results of these AP consensus statements, one should be aware that some agreed methods of VTE prophylaxis are different from those published in international guidelines regarding diagnosis and risk factors and methods of prophylaxis in details.

We hope that this AP VTE consensus will provide orthopedic surgeons who practice in the AP region appropriate options for VTE diagnosis and prevention methods that benefit their patients, with fewer complications.