Summary of the 2021 International Consensus Meeting on Venous Thromboembolism

Background: Venous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism, remains a significant cause of morbidity, mortality, and increased healthcare costs following orthopedic surgery. Despite existing protocols, optimal prophylaxis remains controversial due to the competing risks of thrombotic events and major bleeding complications, alongside a lack of standardized, subspecialty-specific risk stratification tools.

Objective: This article details the methodology and clinical recommendations of the inaugural International Consensus Meeting (ICM) on VTE, aimed at establishing evidence-based standards for VTE prevention across all orthopedic subspecialties.

Key Points: Utilizing a formal Delphi process involving 570 global delegates, the ICM evaluated 200 clinical questions. Key findings include the emergence of low-dose aspirin as a safe, effective, and cost-efficient prophylactic agent for total joint arthroplasty, even in high-risk cohorts. The consensus highlights the necessity of incorporating wound complications and bleeding risks into future personalized risk-scoring models. Subspecialty-specific guidance was developed for trauma, sports medicine, spine, pediatrics, and oncology, addressing variables such as weight-bearing status, immobilization, and surgical duration. While potent anticoagulants like low-molecular-weight heparin remain indicated for multi-trauma patients, routine prophylaxis is often unnecessary for low-risk procedures in hand and sports surgery.

Conclusion: The ICM on VTE provides a comprehensive, peer-reviewed framework to standardize perioperative care. By addressing subspecialty-specific nuances and prioritizing agents with favorable safety profiles, these guidelines aim to reduce VTE incidence while minimizing anticoagulation-related adverse events and establishing a legal standard of care in orthopedic practice.