Reducing blood loss, decreasing transfusion rates, and postoperative venous thromboembolism prophylaxis in total hip arthroplasty

As the literature demonstrating the complications and costs associated with allogeneic blood transfusion after total hip arthroplasty has solidified, the implementation of blood conservation protocols for total joint arthroplasty has become more common. Recent studies have focused on identification and treatment of anemic individuals preoperatively, reduction of intraoperative blood loss through the use of antifibrinolytics and other tools, and the maintenance of strict postoperative transfusion triggers. As antifibrinolytics work by inhibiting the breakdown of blood clots and aggressive venous thromboembolism (VTE), chemoprophylaxis regimens may increase the risk of bleeding complications, blood conservation management strategies and VTE prophylaxis must be considered together. Recent studies have evaluated the safety of antifibrinolytics with regard to VTE rates postoperatively. In addition, the use of aspirin as VTE prophylaxis has resulted in improved bleeding and wound complications rates while keeping VTE rates low. Patient-specific risk stratification scores may help guide VTE chemoprophylaxis treatment regimens with the goal of optimizing VTE prevention while minimizing wound complications.