Venous Thromboembolism Prophylaxis in Total Shoulder Arthroplasty: A Matched Cohort Analysis

Background: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a potentially life-threatening complication following total shoulder arthroplasty (TSA). Despite the increased use of chemical prophylaxis, its effectiveness and safety in TSA populations remain unclear. This study evaluated the incidence of VTE, bleeding events, and related outcomes among TSA patients with and without postoperative chemical prophylaxis. Materials and Methods: A retrospective cohort study was conducted using the TriNetX database, identifying patients who underwent TSA, stratifying into two cohorts: those who received chemical VTE prophylaxis and those who did not. Propensity score matching (1:1) was employed to balance demographics, comorbidities, and other confounding variables. Outcomes, including VTE, bleeding events, prosthetic joint infection (PJI), revision, and mortality, were assessed at 30 days, 90 days, and 6 months postoperatively. Results: After matching, 9,859 patients were included in each cohort. There was no significant difference in the incidence of VTE, PE, or DVT at any time point between the groups. Patients who received prophylaxis showed a reduced risk of ischemic stroke at 30 days (HR 0.539; 95% CI 0.367–0.793; p = 0.001) and myocardial infarction (MI) at both 30 days (HR 0.469; 95% CI 0.306–0.718; p < 0.001) and 90 days (HR 0.720; 95% CI 0.519–0.997; p = 0.047). However, at 6 months, patients with prophylaxis demonstrated an increased risk of mortality (HR 1.812; 95% CI 1.003–3.273; p = 0.046). Conclusion: Chemical prophylaxis did not reduce the risk of VTE after TSA but was associated with a lower incidence of ischemic stroke and MI in the early postoperative period. The increased long-term mortality risk observed in the prophylaxis group warrants further investigation to optimize VTE prevention strategies for TSA patients. Level of evidence: Level III Retrospective Cohort Comparison Using Large Database Prognosis Study