Persistent Lack of International Consensus for Venous Thromboembolism Prophylaxis Recommendations following Total Hip Arthroplasty.

Abstract

Venous thromboembolism (VTE) remains a critical and fatal complication of total hip arthroplasty (THA). Clinical practice guidelines (CPGs) have the ability to change practice and reduce mortality. However, previous guidelines have lacked consensus. The aim of this study was to review the currently available CPGs regarding VTE prophylaxis following THA and assess whether, in 2024, a more global and unified consensus has been reached. Databases were searched for VTE prophylaxis CPGs following THA. Each guideline was assessed using the Appraisal of Guidelines for Research and Evaluation II tool, a verified guideline appraisal tool. Recommendations and level of evidence were extracted from each CPG to be tabulated and compared with the other available guidelines. There were 14 guidelines identified, and all were deemed "recommended" as per Appraisal of Guidelines for Research and Evaluation II. However, there was large heterogeneity between the CPGs, particularly in regard to chemical prophylaxis, with 11 different agents recommended and largely low to moderate supporting evidence. Mechanical prophylaxis was backed by moderate to high levels of evidence. In 2024, there remains a large heterogeneity in available guidelines. Organizations should aim to consider international collaboration before the introduction of updated CPGs.