Date of Award

2018

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

Keywords

TKA; DVT prophylaxis; pharmacology; aspirin; Xa inhibitors; LMWH; warfarin; VTE prophylaxis cost TKA; diagnosing DVT

Abstract

Elective total knee arthroplasty (TKA) is the most frequently performed inpatient surgical procedure in the United States (Kurtz, Ong, Lau, Mowat, & Halpern 2007). Complications of this procedure include deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively referred to as venous thromboembolism (VTE). Various pharmacological agents exist for VTE prophylaxis. Warfarin and low-molecular-weight heparin (LMWH) were commonly used for VTE prophylaxis in the past, but with the emergence of novel anticoagulants including factor Xa inhibitors and direct thrombin inhibitors (DTIs), warfarin is used far less frequently. Aspirin is also approved for VTE prophylaxis. The purpose of this study was to determine if a superior drug or combination of drugs exist for VTE prophylaxis based on patient outcomes, cost effectiveness, and risk profile. This review of literature analyzed studies from the past 10 years that compared aspirin, warfarin, Lovenox, and the novel anticoagulants for VTE prophylaxis in post-operative TKAs. Study outcomes included VTE prevention, bleeding risk, and cost. Reversal agents were also examined. Findings of this author’s literature review demonstrated that currently, no one superior medication exists for prophylaxis of VTE events in patients undergoing TKA (Cafri et al., 2017). However, current research indicates that both factor Xa inhibitors and aspirin have emerged as the medications of choice. Of the two, aspirin is commonly favored as it does not require laboratory monitoring, it is cost effective, and it is available over the counter. It also has less risk of major bleeding compared to factor Xa inhibitors.

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