From the Research
Platelets may be elevated after a right total knee arthroplasty (TKA) due to the body's inflammatory response to surgical trauma, and proper anticoagulation therapy is essential to mitigate the risk of venous thromboembolism. Following major orthopedic surgery like a knee replacement, the body initiates an acute phase reaction that can trigger increased platelet production (thrombocytosis) as part of the healing process. This reactive thrombocytosis is typically temporary and resolves as inflammation subsides. Other factors contributing to elevated platelets include tissue damage, blood loss during surgery requiring compensatory hematopoiesis, and the release of growth factors that stimulate platelet production. While some degree of platelet elevation is expected and often benign, significant thrombocytosis merits attention as it may increase thrombotic risk in TKA patients who are already at higher risk for venous thromboembolism. According to a recent study 1, rivaroxaban ranked first for prevention of deep vein thrombosis, and low molecular weight heparin (LMWH) ranked first in the pulmonary embolism network. Some key points to consider in the management of TKA patients include:
- The use of anticoagulation therapy, such as low molecular weight heparin, direct oral anticoagulants, or aspirin, as prescribed by the surgeon, to mitigate the risk of venous thromboembolism.
- The importance of following the surgeon's specific anticoagulation protocol, typically continuing for 2-6 weeks postoperatively depending on individual risk factors.
- The consideration of a multimodal approach to VTE prophylaxis, using bilateral intra- and postoperative intermittent pneumatic compression, epidural anesthesia, early mobilization, and postoperative aspirin without the use of major anticoagulation, as suggested by a study 2. Overall, the management of TKA patients requires careful consideration of the risk of venous thromboembolism and the use of appropriate anticoagulation therapy to mitigate this risk.