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Thromb Haemost 2022; 122(12): 1969-1979
DOI: 10.1055/s-0042-1757200
Review Article

Obesity and the Risk of Venous Thromboembolism after Major Lower Limb Orthopaedic Surgery: A Literature Review

Authors

  • Usha Gurunathan 

    1   Faculty of Medicine, The University of Queensland, Brisbane, Australia
    2   Department of Anaesthesia and Perfusion Services, The Prince Charles Hospital, Brisbane, Australia

  • Michael Barras

    3   School of Pharmacy, The University of Queensland, Brisbane, Australia
    4   Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia

  • Catherine McDougall

    1   Faculty of Medicine, The University of Queensland, Brisbane, Australia
    5   Department of Orthopaedics, The Prince Charles Hospital, Brisbane, Australia

  • Harshal Nandurkar

    6   Department of Haematology, Alfred Health and Australian Centre for Blood Diseases, Monash University, Melbourne, Australia

  • Victoria Eley

    1   Faculty of Medicine, The University of Queensland, Brisbane, Australia
    7   Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia

Funding None declared.
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Graphical Abstract

Abstract

The risk of venous thromboembolism following total joint arthroplasty is significantly greater than those of other types of elective orthopaedic procedures. This risk is increased in obesity due to the associated prothrombotic physiological and hematological changes that predispose to embolic events. The prevalence of obesity is increasing in the aging population, which contributes to a further increase in the risk of postoperative thrombosis in the older patients. There is a lack of clear evidence regarding dosing information for thromboprophylaxis medications in patients with obesity. As a result, the currently available thromboprophylaxis guidelines do not provide specific recommendations for this group. Suboptimal dosing regimens for these medications can place these patients at a risk of bleeding or clotting complications postsurgery. Hence any increase in dosage may require intensive surveillance for the residual anticoagulant effects and careful balancing of risks and benefits on an individual basis. Our review discusses the basis for increased thrombotic risk in obesity, the evidence supporting dosage recommendations, and the implications of the current guidelines for pharmacological thromboprophylaxis in patients with obesity undergoing lower limb arthroplasty.

Keywords

antithrombotic - arthroplasty - obesity - thromboprophylaxis - venous thromboembolism


Publication History

Received: 07 May 2022

Accepted: 02 August 2022

Article published online:
16 November 2022

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