Venous Thromboembolism Management by American Association of Hip and Knee Surgeons David C. Markel, MD,*z Sally York, MN, y Michael J. Liston Jr, MD, z Jeffrey C. Flynn, PhD, * C. Lowry Barnes, MD, § Charles M. Davis III, MD, PhD ‖ and the AAHKS Research Committee Abstract: A 2008 survey of American Association of Hip and Knee Surgeons membership explored current venous thromboembolism (VTE) protocols for lower-extremity total joint surgery. Fifty-three percent reported a change in VTE-related practices in the last 5 years. More than 70% reported that their primary hospital now mandates VTE prophylaxis. Although 74% of their primary hospitals recognized the American College of Chest Physicians guidelines, 68% of surgeons felt the American Academy of Orthopaedic Surgeons guidelines were more relevant to their practice. Respondents believe low molecular weight heparin to be the most efficacious but aspirin to be the easiest to use and has the lowest risks of bleeding and wound drainage. Warfarin was the most used in hospital prophylaxis, and 90% of respondents targeted an international normalized ratio of 1.6 to 2.5. Practice patterns continue to evolve, and there remains no consensus on specific treatment protocols or preferences. Keywords: venous thromboembolism, total hip arthroplasty, total knee arthroplasty, survey, American Association of Hip and Knee Surgeons, treatment. © 2010 Elsevier Inc. All rights reserved. The current strategies for prophylaxis of venous throm- boembolism (VTE) in lower-extremity total joint surgery warrant review. VTE prophylaxis is an important issue relative to safe and effective patient care. Yet, there is no clear consensus among medical specialists, especially orthopedic surgeons, concerning the appropriate guide- lines for prophylaxis, and there is still marked confusion surrounding best practices. These varied practice pat- terns have potential medical, legal, and hospital compli- ance implications. Many surgeons and hospitals use the guidelines advocated by the American College of Chest Physicians (ACCP, published in 2008) or the American Academy of Orthopaedic Surgeons (AAOS, published in 2007) [1,2]. However, others use protocols that are not currently advocated by either set of guidelines. In 2000, a survey was conducted of the members of the American Association of Hip and Knee Surgeons (AAHKS) on the management of VTE [3]. In this survey, there was universal acceptance of the need for prophy- laxis in total joint surgery; however, there were marked differences in prophylactic pharmacologic agents of choice and treatment modalities. Since these data were collected, new VTE professional guidelines, treatments, research, hospital policies, and practices have been developed and implemented in an attempt to reduce the impact of VTE in joint reconstruction. In addition, ACCP and AAOS guidelines were introduced [1,2]. The current survey was designed to explore the practice changes that have occurred over the last 8 years among the AAHKS membership and to evaluate whether a consensus or standardization in the evaluation and management of VTE events had occurred as a result of the newer national guidelines. Materials and Methods A 5-stage mixed mode (fax/e-mail) survey of all active AAHKS members (n = 840) was conducted between May and June 2008, using Dillman's [4] survey research methods. Human subject criteria were used in the From the *Department of Orthopaedic Surgery, Providence Hospital and Medical Centers, Southfield, Michigan; yNorthWest Orthopaedic Institute, Tacoma, Washington; zDetroit Medical Center/Providence Hospital Orthopaedic Residency Program, Detroit, Michigan; §Arkansas Specialty Orthopaedics, Foundation for Musculoskeletal Research and Education, Little Rock, Arkansas; and ‖ Department of Orthopedic Surgery and Rehabilitation, Pennsylvania State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania. Supplementary material available at www.arthroplastyjournal.org. Submitted May 12, 2009; accepted July 23, 2009. No benefits or funds were received in support of the study. Reprint requests: David C. Markel, MD, Department of Orthopaedic Surgery, Providence Hospital and Medical Centers, Detroit Medical Center/Providence Hospital Orthopaedic Residency Program, 22250 Providence Drive, Suite #401, Southfield, MI 48075. © 2010 Elsevier Inc. All rights reserved. 0883-5403/09/2501-0002$36.00/0 doi:10.1016/j.arth.2009.07.021 3 The Journal of Arthroplasty Vol. 25 No. 1 2010