The Journal of Arthroplasty

The DVT rate for the post-discharge protocol of Aspirin and Portable Mechanical Compression therapy group was 0%. The DVT rate for the post-discharge protocol of just Aspirin group was 23.1%

CHEST Guidelines

In patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA), we recommend use of one of the following for a minimum of 10 to 14 days rather than no antithrombotic prophylaxis: low-molecular-weight heparin (LMWH), fondaparinux, apixaban, dabigatran, rivaroxaban, low-dose unfractionated heparin (LDUH), adjusted-dose vitamin K antagonist (VKA), aspirin (all Grade 1B), or an intermittent pneumatic compression device (IPCD) (Grade 1C).

Remarks: We recommend the use of only portable, battery-powered devices capable of recording and reporting proper wear time on a daily basis for inpatients and outpatients. One panel member believed strongly that aspirin alone should not be included as an option.

AAOS Guidelines

RECOMMENDATION 5

We suggest the use of pharmacologic agents and/or mechanical compressive devices for the prevention of venous thromboembolic disease in patients undergoing elective hip or knee arthroplasty, and who are not at elevated risk beyond that of the surgery itself for venous thromboembolism or bleeding.

Grade of Recommendation: Moderate

The Journal of Bone and Joint Surgery

A Prospective Randomized Trial Comparing a Mobile Compression Device with Low Molecular Weight Heparin.
Results: There was no statistical difference between the groups in the incidence of VTE. Portable sequential devices did show a significant decrease in major bleeding events versus enoxaparin.

Interpretation: If Circul8 can prevent blood clots just as much as a pharmacologic option without the risks of a major bleeding event, the standard hospital protocol should be a baby aspirin and Circul8.

RESULTS:
The DVT rate for the postdischarge MCD therapy group was 0% and 23.1% for the inpatient MCD group (P < .001). All DVTs resolved by 3 months postoperatively. Patient satisfaction was 9.56 (±0.82) for postdischarge MCD patients vs 8.50 (±1.46) for inpatient MCD patients (P < .001).

CONCLUSION:
Limited tourniquet TKA patients who were mobilized early, managed with aspirin for 3 weeks postoperatively, and on MCD therapy for up to 6 weeks postoperatively experienced superior DVT prophylaxis than patients receiving MCD therapy only as an inpatient (P < .05). The 0% incidence of nonsymptomatic DVTs prevented by aspirin and extended-use MCD further validates this type of prophylaxis in low DVT risk TKA patients.

Joint Commission

The prevention of adverse drug events (ADEs) is an important patient safety priority. We’ve learned that anticoagulants are among the most common medications causing adverse drug events. According to the U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, ADEs account for an estimated one-third of hospital adverse events and approximately 280,000 hospital admissions annually.