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Коллеги! Хочу поделиться обновленной версией гайда AAOS

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Specific recommendations for patients undergoing elective hip or knee arthroplasty include the following:

-strong recommendation against routine postoperative duplex ultrasonography screening;
-weak recommendation for determining whether patients have had a previous VTE, which increases already high VTE risk;
-consensus recommendation for evaluating patients for known bleeding disorders such as hemophilia and for the presence of active liver disease, which further increase the risk for bleeding and bleeding-associated complications;
-moderate recommendation to discontinue antiplatelet agents before undergoing the procedure;
-moderate recommendation to use pharmacologic agents and/or mechanical compressive devices to prevent VTE in patients who are not at elevated risk (beyond that of the surgery itself) for VTE or bleeding — however, evidence is insufficient to recommend any particular preventive strategy or the duration of these treatments. Consensus recommendation in duration of prophylaxis, therefore, is that physicians discuss this with patients;
-consensus recommendation for pharmacologic prophylaxis and mechanical compressive devices in patients who have had a previous VTE;
-consensus recommendation for use of mechanical compressive devices to prevent VTE in patients who have a known bleeding disorder and/or active liver disease;
-consensus recommendation that patients undergo early postoperative mobilization: Evidence is insufficient that early mobilization reduces DVT rates, but this intervention is low cost, of minimal risk, and consistent with current practice;
-moderate recommendation for the use of neuraxial (eg, intrathecal, epidural, or spinal) anesthesia to help limit blood loss, even though evidence suggests that neuraxial anesthesia does not affect VTE occurrence;
-inconclusive recommendation regarding whether or not inferior vena cava filters should be used to prevent PE in patients who have a contraindication to chemoprophylaxis and/or known residual venous thromboembolic disease.