The Journal of arthroplasty
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Blood management in the perioperative period of the total joint arthroplasty procedure has evolved over the last 3 decades. Strategies have changed and are changing based on a better understanding of blood loss and blood replacement options in this patient population. Patient-specific options based on preoperative hemoglobin levels and patient comorbidities as well as anticipated blood loss have been developed and studied. Patient-specific blood management programs have provided cost-efficient care with low morbidity.
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Venous thromboembolism is a recognized complication of total hip arthroplasty, knee arthroplasty, and hip fracture surgery. Various pharmacological agents have been introduced in orthopedic surgery in an attempt to reduce the mortality as well as the short-term and long-term morbidity associated with the development of deep vein thrombosis and pulmonary embolism. ⋯ The most current guidelines of the American College of Chest Physicians regarding thromboprophylaxis after total hip arthroplasty, total knee arthroplasty, and hip fracture surgery give the highest recommendations in support of the use of low-molecular-weight heparin, warfarin, or fondaparinux. Their highest recommendation is also given against the use of aspirin due to its lack of demonstrated efficacy.