Anticoagulation Dosing for VTE Prophylaxis Following Hip Hemiarthroplasty

Primary Pharmacological Options

The American College of Chest Physicians recommends rivaroxaban 10 mg orally once daily for 35 days as the first-line option for VTE prophylaxis after hip arthroplasty, with a strength of evidence grade of 1B 1, 2
The Mayo Clinic recommends enoxaparin 40 mg subcutaneously once daily or 30 mg subcutaneously twice daily for VTE prophylaxis after hip arthroplasty, with a strength of evidence grade of 1B 1, 3
The American College of Chest Physicians recommends apixaban 2.5 mg orally twice daily for 35 days as an alternative option for VTE prophylaxis after hip arthroplasty, with a strength of evidence grade of 1B 4, 5, 6

The American College of Chest Physicians recommends a minimum of 10-14 days of prophylaxis, with extended prophylaxis up to 35 days strongly recommended for hip arthroplasty, with a strength of evidence grade of 1B 3
The RECORD 2 trial demonstrated that extended rivaroxaban (31-39 days) was more effective than short-term enoxaparin without increased bleeding, with a strength of evidence grade of 1B 1, 2

The American College of Chest Physicians recommends intermittent pneumatic compression (IPC) in addition to pharmacological prophylaxis for 18 hours daily, with a strength of evidence grade of 1B 3

The American College of Chest Physicians recommends reducing fondaparinux to 1.5 mg daily for patients with CrCl 30-50 mL/min, with a strength of evidence grade of 1B 3
The American College of Chest Physicians recommends avoiding rivaroxaban in patients with CrCl <15 mL/min, with a strength of evidence grade of 1B 3

The American College of Chest Physicians warns against underdosing duration, with 42-58% of at-risk patients not receiving appropriate extended prophylaxis despite clear guidelines, with a strength of evidence grade of 1B 3
The American College of Chest Physicians warns against ignoring renal function, with failure to adjust dosing for renal impairment leading to drug accumulation and bleeding, with a strength of evidence grade of 1B 3
The American College of Chest Physicians warns against drug interactions, with potent CYP3A4 and P-glycoprotein inhibitors (ketoconazole, ritonavir) being contraindicated with rivaroxaban, with a strength of evidence grade of 1B 4, 5