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Patient handout

Post-orthopedic-arthroplasty DVT (post-THA/TKA/hip-fracture; ASA vs DOAC vs LMWH per AAOS 2025 + ACCP)

PRODUCTION

1. Your condition

This handout is for post-orthopedic-arthroplasty dvt (post-tha/tka/hip-fracture; asa vs doac vs lmwh per aaos 2025 + accp). Your care team identified this based on: unilateral lower-extremity swelling, calf pain, or whole-leg swelling within 4-6 weeks of tha / tka / hip-fracture surgery — post-arthroplasty vte pretest probability sharply elevated.

Other reasons your team may use this plan: documented tha / tka / hip-fracture-surgery within preceding 6 weeks — anchor the surgical provoking factor and prophylaxis history (regimen + adherence + duration completed); new pleuritic chest pain, dyspnea, syncope, hemoptysis, or unexplained tachycardia within 35 days of tha / hip-fracture surgery (12 days for tka) — concurrent pe screen mandated; ctpa if wells pe > 4 or perc fail; incidental dvt identified on post-op ct (e.g., for fever workup or pe screen) in arthroplasty patient — confirm + manage per symptomatic vs surveillance distinction.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

MedicationStarting doseHowWhenWhat it does
apixabanTreatment: 10 mg BID × 7 d → 5 mg BID × 3 mo; Extended prophylaxis: 2.5 mg BID × 35 d post-THA or × 12 d post-TKA per ADVANCE-2/3POBIDTreatment: AMPLIFY (Agnelli NEJM 2013 PMID 23808982) — apixaban first-line for established VTE; Prophylaxis: ADVANCE-2 (Lassen Lancet 2010 PMID 20206776) and ADVANCE-3 (Lassen NEJM 2010 PMID 21142528) — 2.5 mg BID superior to enoxaparin for prophylaxis; AAOS 2025 + ACCP 2021 first-line option
rivaroxabanTreatment: 15 mg BID × 21 d → 20 mg daily × 3 mo; Extended prophylaxis: 10 mg daily × 35 d post-THA or × 12 d post-TKA per RECORD-1/2/3POBID then daily; 10 mg daily for prophylaxisTreatment: EINSTEIN-DVT (Bauersachs NEJM 2010 PMID 21128814); Prophylaxis: RECORD-1/2/3 (Eriksson NEJM 2008 PMID 18579812; Kakkar Lancet 2008 PMID 18582928; Lassen NEJM 2008 PMID 18579811) — rivaroxaban 10 mg daily superior to enoxaparin for prophylaxis; EPCAT-II (Anderson NEJM 2018 PMID 29466159) — ASA non-inferior to rivaroxaban for symptomatic VTE prevention after 5-d rivaroxaban lead-in
aspirinProphylaxis: 81 mg PO BID × 30 d post-THA or × 14 d post-TKA after 5-day rivaroxaban or enoxaparin lead-in (per AAOS 2025 + EPCAT-II; standard-risk patients only)POBID for prophylaxis (NOT for symptomatic DVT treatment)EPCAT-II (Anderson NEJM 2018 PMID 29466159) — ASA 81 mg BID after 5-d rivaroxaban lead-in NON-INFERIOR to continued rivaroxaban for symptomatic VTE prevention after THA/TKA; AAOS 2025 Strong recommendation in standard-risk patients; do NOT use ASA monotherapy in high-risk patients (prior VTE, active cancer, thrombophilia, BMI >40, hip-fracture surgery); never substitute for treatment-dose AC in symptomatic established DVT
enoxaparinTreatment: 1 mg/kg SC BID (1 mg/kg daily if CrCl <30); Prophylaxis: 40 mg SC daily (THA/TKA) or 30 mg SC q12h (HFS or extended); 35-d post-THA or 12-d post-TKASCBID treatment; daily or q12h prophylaxisASH 2020 (PMID 33007077); ACCP 2021; AAOS 2025 — LMWH first-line option for high-risk arthroplasty patients and HFS; pre-op LMWH considered if HFS surgery delayed >12 h per HIP-ATTACK (Borges Lancet 2020 PMID 32325025)
dabigatranProphylaxis: 220 mg PO daily after 1-4 h post-op half-dose start × 35 d (THA) or × 10 d (TKA) per RE-NOVATE / RE-MODELPOdailyRE-NOVATE / RE-MODEL — dabigatran 220 mg daily non-inferior to enoxaparin for prophylaxis; less commonly chosen than apixaban or rivaroxaban; CrCl <30 contraindication
warfarin5 mg daily; INR target 2-3 for treatment of established post-op DVT; for prophylaxis target INR 1.8-2.2 (less commonly used since DOAC era)POdailyTRAPS (Pengo Blood 2018) — warfarin > rivaroxaban in triple-positive APS; reasonable alternative if DOAC contraindicated; CrCl <15 → warfarin only; mechanical heart valve patients undergoing arthroplasty need warfarin bridge planning
heparin80 U/kg IV bolus + 18 U/kg/h targeting aPTT 1.5-2.5×IVcontinuousReversibility for acute peri-procedural management; ACCP 2021; reasonable for patients with planned return to OR or active bleed risk requiring rapid AC reversal
intermittent pneumatic compression (IPC)Continuous IPC bilateral lower extremities while in hospital (or non-operated leg if surgical-site precludes ipsilateral)mechanicalcontinuous in hospitalCLOTS-3 (Dennis Lancet 2013 PMID 23484795) — IPC reduces DVT in immobile patients; ACCP 2021 + AAOS 2025 — universal in-hospital adjunct; may serve as primary prophylaxis if pharmacologic AC contraindicated
fondaparinuxProphylaxis: 2.5 mg SC daily × 35 d post-THA or × 12 d post-TKA starting 6-8 h post-op (PENTHIFRA / EPHESUS)SCdailyPENTHIFRA / EPHESUS — fondaparinux non-inferior to enoxaparin for arthroplasty prophylaxis; HIT-safe alternative; renal contraindication CrCl <30

Plan: Post-arthroplasty DVT — treatment-dose AC for symptomatic post-op DVT (3 mo provoked) PLUS framework for extended prophylaxis (35 d hip / 12 d knee per AAOS 2025 + ACCP 2021) and risk-tiered drug choice (ASA non-inferior to DOAC for standard-risk per EPCAT-II)

3. When to call your provider

Contact your care team if any of the following happen:

  • New VTE despite prevention plan → restart AC + evaluate for thrombophilia + consider extended-phase AC
  • Pregnancy → switch to LMWH per ASH 2018
  • Future arthroplasty (contralateral or revision) → extended prophylaxis cycle (35 d hip / 12 d knee)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

  • New DVT or PE in post-arthroplasty patient with documented compliance with prophylactic regimen (rivaroxaban 10 mg daily, ASA 81 mg BID, enoxaparin 40 mg daily, apixaban 2.5 mg BID) — prophylaxis-failure scenario warrants escalation to treatment-dose AC + thrombophilia consideration + drug interaction review
  • Post-major-orthopedic-surgery patient (THA / TKA / HFS) within 35-day RECORD prophylaxis window develops massive PE with sustained hypotension or cardiac arrest(life-threatening)
  • Sudden back pain + new lower-extremity neurologic deficit (weakness, sensory loss, urinary retention) in patient with recent neuraxial (spinal/epidural) anaesthesia + recent AC administration — spinal hematoma is a surgical emergency(life-threatening)
  • Platelet drop >50% from baseline 5-14 days into LMWH prophylaxis with new lower-extremity thrombosis — HIT with HITT (HIT-related thrombosis) confirmed by 4T score ≥6 + serotonin-release assay or anti-PF4 ELISA positive(life-threatening)

5. Follow-up

STOP AC at 3 mo for provoked-by-reversed-factor presentation per ACCP 2021; 6-wk orthopedic follow-up confirms substrate reversal (ambulatory, prosthesis healed); future arthroplasty (contralateral or revision) requires the same extended-prophylaxis cycle; reinforce future-surgical-prophylaxis awareness; cardiac rehab if HFS in elderly patient

6. Sources

Guideline: AAOS 2025 VTE Prophylaxis Post-Arthroplasty + ACCP/CHEST 2021 (Stevens) + RECORD program + EPCAT-II + ASRA 2018 neuraxial AC

  1. pubmed.ncbi.nlm.nih.gov/34352295
  2. pubmed.ncbi.nlm.nih.gov/33007077
  3. pubmed.ncbi.nlm.nih.gov/30482764