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

Venous Thromboembolism Prophylaxis in Total Shoulder Arthroplasty: A Matched Cohort Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Venous Thromboembolism Prophylaxis in Total Shoulder Arthroplasty: A Matched Cohort Analysis Akhil Katakam, Tej Joshi, Thomas Soussou, Francis Sirch, Daniella Ogilvie, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7294844/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Apr, 2026 Read the published version in Archives of Orthopaedic and Trauma Surgery → Version 1 posted 10 You are reading this latest preprint version Abstract 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 DVT prophylaxis Total Shoulder Arthroplasty TriNetX Bleeding Risk Pulmonary Embolism DVT PE Introduction Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a morbid and potentially fatal complication following total shoulder arthroplasty (TSA). Reported incidences range widely from 0.2–16%, with larger database studies reporting a VTE incidence of 0.24 to 0.68%.[16; 17; 21] However, the potentially severe consequences of undiagnosed or untreated VTE, including patient mortality, highlight the importance of effective prevention strategies.[ 20 ] Additionally, by 2030, the demand for shoulder arthroplasty is projected to increase eightfold among all patients and sevenfold among those over 55, compared to levels over a decade earlier.[ 15 ] This demonstrates the need for a consensus on optimal VTE prophylaxis strategies to accommodate the rising number of procedures while ensuring patient safety. The risk of VTE after TSA is multifactorial and influenced by multiple patient and procedure-specific factors. Conditions such as hypoalbuminemia, extended hospital stays, older age, African American ethnicity, and fracture-related indications for surgery have all been linked to elevated VTE risk.[ 11 ] However, the utility of standardized chemical or mechanical prophylaxis in addressing these risks remains inadequately defined. The American Academy of Orthopaedic Surgeons (AAOS) does not have strict guidelines on the use of chemical prophylaxis on patients undergoing TSA and recommends an individual patient risk assessment.[ 7 ] VTE prophylaxis has been well-defined in lower extremity arthroplasty, but has not yet carried over to TSA.[ 5 ] The use of agents like aspirin and direct factor Xa inhibitors has increased in recent years, but their comparative effectiveness and safety profiles in TSA populations are not well-established.[1; 9] One study looked at VTE before and after implementation of the 2007 National Institute for Health and Clinical Excellence (NICE) guidelines on patients undergoing upper extremity surgery. [8; 12] These guidelines recommended the use of low molecular weight heparin (LMWH) for the length of the hospital stay in patients over the age of 60, those who were obese, those who had operations longer than 90 minutes, and those with significant co-morbidities. Regarding TSA, they found no significant decrease in VTE and concluded that the use of chemoprophylaxis did not decrease VTE risk. This study was limited, however, in only examining LMWH as a chemoprophylactic agent. Therefore, this study compares outcomes among patients who underwent TSA with and without standardized VTE prophylaxis, looking at any chemoprophylactic agent. We aim to assess the incidence of VTE, bleeding events, and related outcomes within the 90-day postoperative period. Materials and Methods Data Source and Study Population A retrospective cohort study design was used to determine all patients who underwent TSA with a minimum follow up of 3 months utilizing the TriNetX database. These patients were isolated utilizing CPT 23472 with any subsequent follow at 3 months postoperative. Patients were then excluded if they had any prior history of PE or DVT within 5 years of the index TSA, as well as, any patients who was received anticoagulation within 30 days of the TSA. All data is in the TriNetX database is organized based on the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), Current Procedural Terminology (CPT), and prescription data. Because the database contains deidentified data and patient records, Institutional Review Board approval was not required. Once this initial cohort of patients was established, they were stratified into two separate cohorts. Those who received DVT prophylaxis in the form of enoxaparin, argatroban, rivaroxaban, fondaparinux, apixaban, dabigatran, aspirin, or warfarin, and those who did not. This was identified utilizing associated RXNorm codes for the respective medications. Propensity Matching The TriNetX platform allows propensity matching in a 1:1 ratio, employing logistic regression. The platform uses greedy nearest-neighbor matching with a caliper of 0.1 pooled standard deviations to propensity match. In this study, propensity matching was used to balance certain potential confounding variables between the two groups. Included variables in the propensity match included demographics (age, race, sex), medical comorbidities (overweight and obesity, hypertension, ischemic heart disease, other forms of heart disease, arterial disease, coagulation defects. All variables after 1:1 propensity score matching were not significantly different between the two groups (Table I). ​​ Outcomes Outcome measures were analyzed at 30-day, 90-day, and 6-month time points. The outcomes were grouped into surgical outcomes, medical outcomes, and laboratory value outcomes. The surgical outcome includes prosthetic joint infection (PJI), revision, wound breakdown, and hematoma. Medical outcomes included head bleed, gastrointestinal (GI) bleed, respiratory bleed, deep venous thrombosis (DVT), pulmonary embolism (PE), ischemic stroke, myocardial infarction (MI), and death. Available laboratory outcomes included hemoglobin and hematocrit. All outcomes were identified with ICD-10-CM codes or CPT codes For patient protection and confidentiality, TriNetX reports any categorical outcomes with less than 10 patients as 10 in the risk calculation. Results were reported with hazard ratio (HR), 95% confidence intervals (CI), and associated p values with Kaplan-Meier survical analysis. For continuous variables, T-test was performed. The significance threshold for all results was set at p < 0.05. Results After the initial query on January 2, 2025, to include patients who had surgery at least 3 month follow up, 11,719 patients who received DVT prophylaxis and 10,505 patients who did not receive DVT prophylaxis were identified. After 1:1 propensity score matching, 9,859 were established in each cohort for analysis. Surgical Outcomes At all time points, there was no significant difference in risk of PJI, revision, wound breakdown, or hematoma between the patients who received DVT prophylaxis and those who did not. The overall risk of hematoma at 30 and 90 days was 0.2% and 0.3%, respectively, for both cohorts. Medical Outcomes At 30 days, patients receiving DVT prophylaxis had a 0.539 times lower risk of subsequent ischemic stroke (95% CI 0.367–0.793, p = 0.001). Likewise, at 30 days, those patients were at 0.469 times lower risk of MI (95% CI 0.306–0.718, p < 0.001). At 90 days, there was no significant difference between the risk of ischemic stroke between the two groups. However, those who received DVT prophylaxis continued to have a significantly decreased risk of MI (HR 0.720, 95% CI .519–0.997, p = 0.047). At all time points, the use of DVT prophylaxis did not decrease the risk of DVT or PE. However, at 6 months, patients who received DVT prophylaxis were at 1.812 higher times the risk of death (95% CI 1.003–3.273, p = 0.046). Laboratory Values At 30 days (11.3 ± 1.7 versus 11.4 ± 1.7, p = 0.011) and 6 months (12.2 ± 1.9 versus 12.3 ± 1.9, p = 0.034), hemoglobin values were statistically lower among the DVT prophylaxis cohort. There was no difference of hematocrit values at any time point between the two groups. Discussion This study evaluated medical and surgical complications in patients undergoing total shoulder arthroplasty, comparing those who received venous thromboembolism prophylaxis with those who did not. No significant differences between groups regarding postoperative deep vein thrombosis, pulmonary embolism or surgical complications such as prosthetic joint infection revision surgery, wound breakdown, and hematoma formation at both 30 and 90 days were found. However, patients receiving prophylaxis had reduced rates of ischemic stroke and myocardial infarction within the first 30 days. The protective effect against ischemic stroke was found to be temporary, but the decreased risk of MI persisted at 90 days. Unexpectedly, an increase in 6-month mortality was observed in those who received VTE prophylaxis. These findings highlight the complexity of VTE prophylaxis decision-making when evaluating its use in total shoulder arthroplasty. The incidence of VTE and PE in our study is consistent with past literature and suggests that clinically significant VTE following TSA is rare.[6; 10; 12; 21] Rates of symptomatic DVT and PE following TSA are typically reported between 0.2% and 2% in large-scale studies; however, observational data suggest the true incidence may be higher in patients with specific comorbidities.[6; 10; 12; 16; 21] Additionally, true incidence rates may be much higher if asymptomatic cases are included which often go undetected without routine imaging.[6; 10; 12; 16; 21] The role of thromboprophylaxis in shoulder arthroplasty remains debated. Hole et al. reviewed the Norwegian arthroplasty registry and reported no significant association between thromboprophylaxis use and postoperative mortality.[ 6 ] Kolz et al. identified advanced age and traumatic indications as significant risk factors for VTE and recommended prophylaxis primarily for patients with multiple risk factors, such as active malignancy, previous VTE, or coagulopathy.[ 10 ] Lung et al. corroborated the significance of elderly age and identified African American ethnicity as an additional risk factor, though obesity, smoking, malignancy, and operative time were not associated with increased VTE risk.[ 11 ] Conversely, Zhang et al.. reported that advanced age, higher BMI, and prolonged operative durations were associated with higher risks of both DVT and PE.[ 21 ] While these studies provide insight into risk stratification, they offer limited evaluation of whether prophylaxis meaningfully reduces medical or surgical complications. Moreover, the mortality benefit associated with VTE prophylaxis remains unclear, as evidenced by Hole et al. and Jameson et al.’s 2011 study, which found no improvement in mortality following the implementation of low molecular weight heparin after the 2007 NICE guidelines.[6; 8] As these studies were limited to LMWH, the broader impact of chemoprophylaxis on postoperative outcomes remains unclear. Our findings showed no significant difference in symptomatic DVT or PE rates between patients who received chemoprophylaxis and those who did not, supporting the low overall risk of VTE in the general TSA population. However, observed reductions in 30-day ischemic stroke and 90-day MI rates suggest potential supplementary benefits of VTE prophylactic agents, such as aspirin and direct oral anticoagulants (DOACs), that extend beyond VTE prevention. Historically, VTE risk has been linked to Virchow’s triad: intimal injury, hypercoagulability, and venous stasis. Specific to TSA, additional intraoperative risk factors include extreme humeral positioning, sharp retractors causing micro injury to vessel walls, compression of the axillary vessels by retractors, and cement-associated hypercoagulability.[16; 19] Intraoperatively, patients are often positioned in the beach chair setup, which may promote femoral vein stasis due to prolonged hip flexion, compounded by postoperative immobilization in a sling.[16; 19] Two of the most common agents used for VTE prophylaxis are aspirin and DOACs such as apixaban, rivaroxaban, and dabigatran. Aspirin irreversibly inhibits COX-1 and platelet aggregation, making it effective in preventing arterial thrombotic events including MI and stroke.[4; 13; 14] DOACs, which inhibit factor Xa or thrombin, reduce venous thrombosis via inhibition of fibrin formation, but may also reduce arterial thrombosis by limiting thrombin-mediated platelet activation.[ 3 ] In orthopedic surgery patient populations, aspirin has shown effectiveness in reducing VTE risk following total joint arthroplasty and may reduce stroke risk after TSA.[4; 13; 14] Our findings suggest that aspirin pharmacologic VTE prophylaxis may confer protection against arterial thrombosis, while having limited observable impact on venous thromboses.[2; 13; 18] This discrepancy can be explained by differences in thrombosis biology. Arterial clots are driven by platelet aggregation and are effectively suppressed by the aspirin-based regimens, whereas venous clots are fibrin driven and are likely infrequent or subclinical to appreciably a clinically observable decrease. Additionally, asymptomatic venous clots likely go undetected in routine clinical care, which may obscure any potential benefit of prophylaxis. Prophylaxis reduces platelet-mediated complications through its antiplatelet and anticoagulant effects. However, the low baseline risk of symptomatic VTE following TSA limits the ability to detect a clinically significant reduction. Future research should focus on better detecting silent VTE to see they may confer additional previous undetected risks, refining prophylaxis choices, and confirming outcomes of specific anticoagulants in prospective trials. Our study found an increase in 6-month mortality among patients receiving prophylaxis. This finding should be interpreted with caution due to several confounding factors. While certain anticoagulants may be associated with delayed adverse events, including gastrointestinal bleeding, hemorrhagic stroke, or other complications that could contribute to late mortality, it is more likely that patients who necessitated VTE prophylaxis had underlying risk factors that were unable to be adequately matched within our dataset and conferred a higher baseline mortality risk. Additionally, variability in arthroplasty type, surgical indications such as fracture or rheumatoid arthritis, and other clinical complexities may not be fully captured in the TriNetX dataset. DVT and PE events were identified based on documented clinical coding, which are typically documented only in symptomatic patients. Additionally, we were unable to account for patient frailty, and mobility status which are prone to influence both the decision to prescribe prophylaxis and patient outcomes. Unmeasured confounders such as genetic predisposition, socioeconomic status, and the use of concurrent medications like tamoxifen or hormone therapy may also contribute to residual bias. A lack of data on the duration, frequency, and limited stratified analysis of specific prophylaxis agent used further complicate interpretation due to differences in risk profiles of medications and mechanisms of action. These limitations emphasize the need for prospective, risk-stratified studies that capture detailed treatment regimens. These future studies will be critical to better understanding the relationship between VTE prophylaxis and late mortality and refining postoperative protocols in shoulder arthroplasty. 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 absence of a reduction in VTE and the observed increase in 6-month mortality raise concerns about the universal application of prophylaxis and suggest that a more individualized, risk-based approach is warranted beyond what has been described in previous literature. Our findings emphasize the need for high-quality, prospective studies to guide agent selection, prophylaxis duration, and appropriate patient selection, ultimately helping optimize postoperative care and patient safety in the shoulder arthroplasty population. Declarations Author Contribution AK, TJ, TS, FS, DO, TJ, TY, and JE contributed to the conceptualization, methodology, data collection, validation, writing—original draft preparation, and writing—review and editing of the manuscript. 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J Am Acad Orthop Surg 30(19):949–956 Tables Table I Propensity matching criteria for patients with and without DVT prophylaxis after total shoulder arthroplasty Before Matching After Matching DVT PPx (n=11,719) No DVT PPx (n=10,505) P value DVT PPx (n=9,859) No DVT PPx (n=9,859) P value Age (SD) 69.4 (9.0) 68.7 (9.0) 0.000 69.0 (9.0) 69.0 (8.7) 0.529 Sex, n (%) Male 4786 (40.8) 4651 (44.27) 0.000 4304 (43.7) 4314 (43.8) 0.886 Female 5976 (51.0) 5569 (53.01) 0.003 5269 (53.4) 5260 (53.4) 0.898 Unknown 957 (8.2) 285 (2.71) 0.000 286 (2.9) 285 (2.9) 0.966 Race American Indian or Alaska Native 24 (0.2) 23 (0.22) 0.819 20 (0.2) 23 (0.2) 0.647 Asian 80 (0.7) 178 (1.69) 0.000 80 (0.8) 76 (0.8) 0.748 Black or African American 555 (4.7) 628 (5.98) 0.000 539 (5.5) 528 (5.4) 0.729 Native Hawaiian or Other Pacific Islander 13 (0.1) 40 (0.38) 0.000 13 (0.1) 13 (0.1) 1.000 White 9450 (80.6) 8465 (80.58) 0.914 8293 (84.1) 8336 (84.6) 0.400 Other Race 174 (1.5) 310 (2.95) 0.000 169 (1.7) 160 (1.6) 0.617 Unknown Race 1423 (12.1) 861 (8.20) 0.000 745 (7.6) 723 (7.3) 0.551 Commodities, n (%) Coagulation Defects 743 (6.3) 662 (6.30) 0.907 604 (6.1) 626 (6.4) 0.517 Arterial Diseases 2227 (19.0) 1941 (18.48) 0.316 1802 (18.3) 1856 (18.8) 0.323 Ischemic Heart Disease 2619 (22.3) 2076 (19.76) 0.000 1976 (20.0) 2019 (20.5) 0.446 Other Hear Disease 4277 (36.5) 3297 (31.39) 0.000 3272 (33.2) 3228 (32.7) 0.505 Overweight and obesity 4624 (39.5) 3648 (34.73) 0.000 3603 (36.5) 3566 (36.2) 0.584 Hypertension 8029 (68.5) 6745 (64.21) 0.000 6499 (65.9) 6462 (65.5) 0.579 DVT, deep venous thrombosis; PPx, prophylaxis Table II Survival analysis at 30 days for patients with and without DVT prophylaxis after total shoulder arthroplasty DVT PPx (n=9,859) No DVT PPx (n=9,859) HR (95% CI) P Value Surgical Outcomes PJI 49 (0.5) 50 (0.5) 0.981 (0.661 - 1.454) 0.922 Revision 45 (0.5) 48 (0.5) 0.938 (0.625 - 1.409) 0.758 Wound Breakdown 14 (0.1) 19 (0.2) 0.737 (0.369 - 1.470) 0.384 Hematoma 16 (0.2) 22 (0.2) 0.728 (0.382 - 1.385) 0.331 Medical Outcomes Head Bleed 10 (0.1) 10 (0.1) 0.600 (0.143 - 2.511) 0.48 GI Bleed 34 (0.3) 37 (0.4) 0.919 (0.577 - 1.464) 0.722 Respiratory Bleed 10 (0.1) 10 (0.1) 1.286 (0.479 - 3.454) 0.616 DVT 55 (0.6) 53 (0.5) 1.039 (0.712 - 1.515) 0.843 PE 19 (0.2) 21 (0.2) 0.905 (0.487 - 1.684) 0.753 Ischemic Stroke 40 (0.4) 74 (0.8) 0.539 (0.367 - 0.793) 0.001 MI 31 (0.3) 66 (0.7) 0.469 (0.306 - 0.718) <0.001 Death 10 (0.1) 10 (0.1) - 1.000 Laboratory Outcomes Hemoglobin 11.3 (1.7) 11.4 (1.7) N/A 0.011 Hematocrit 34.4 (5.2) 34.3 (6.3) N/A 0.768 HR, hazard ratio; PJI, prosthetic joint infection; GI, gastrointestinal; DVT, deep venous thrombosis PE, pulmonary embolism; MI, myocardial infarction Table III Survival analysis at 90 days for patients with and without DVT prophylaxis after total shoulder arthroplasty DVT PPx (n=9,859) No DVT PPx (n=9,859) HR (95% CI) P Value Surgical Outcomes PJI 79 (0.8) 88 (0.9) 0.898 (0.663 - 1.217) 0.488 Revision 105 (1.1) 100 (1.0) 1.051 (0.799 - 1.382) 0.721 Wound Breakdown 29 (0.3) 39 (0.4) 0.744 (0.460 - 1.203) 0.226 Hematoma 25 (0.3) 29 (0.3) 0.862 (0.505 - 1.472) 0.587 Medical Outcomes Head Bleed 10 (0.1) 13 (0.1) 0.770 (0.338 - 1.756) 0.533 GI Bleed 63 (0.6) 69 (0.7) 0.913 (0.649 - 1.285) 0.692 Respiratory Bleed 23 (0.2) 18 (0.2) 1.279 (0.690 - 2.371) 0.432 DVT 78 (0.8) 76 (0.8) 1.028 (0.749 - 1.409) 0.866 PE 28 (0.3) 32 (0.3) 0.876 (0.527 - 1.454) 0.608 Ischemic Stroke 81 (0.8) 105 (1.1) 0.770 (0.576 - 1.029) 0.076 MI 62 (0.6) 86 (0.9) 0.720 (0.519 - 0.997) 0.047 Death 10 (0.1) 10 (0.1) 1.335 (0.299 - 5.964) 0.704 Laboratory Outcomes Hemoglobin 11.8 (1.8) 11.9 (1.8) N/A 0.054 Hematocrit 35.8 (5.8) 35.7 (6.6) N/A 0.55 HR, hazard ratio; PJI, prosthetic joint infection; GI, gastrointestinal; DVT, deep venous thrombosis PE, pulmonary embolism; MI, myocardial infarction Table IV Survival analysis at 6 months for patients with and without DVT prophylaxis after total shoulder arthroplasty DVT PPx (n=9,859) No DVT PPx (n=9,859) HR (95% CI) P Value Surgical Outcomes PJI 104 (1.1) 111 (1.1) 0.935 (0.716 - 1.222) 0.624 Revision 156 (1.6) 156 (1.6) 0.999 (0.800 - 1.247) 0.993 Wound Breakdown 40 (0.4) 44 (0.4) 0.908 (0.592 - 1.394) 0.659 Hematoma 32 (0.3) 36 (0.4) 0.888 (0.551 - 1.429) 0.624 Medical Outcomes Head Bleed 16 (0.2) 21 (0.2) 0.760 (0.397 - 1.457) 0.408 GI Bleed 93 (0.9) 97 (1.0) 0.957 (0.720 - 1.271) 0.76 Respiratory Bleed 37 (0.4) 34 (0.3) 1.086 (0.682 - 1.730) 0.728 DVT 97 (1.0) 94 (1.0) 1.031 (0.777 - 1.370) 0.831 PE 39 (0.4) 38 (0.4) 1.025 (0.656 - 1.603) 0.912 Ischemic Stroke 111 (1.1) 139 (1.4) 0.795 (0.620 - 1.021) 0.071 MI 100 (1.0) 117 (1.2) 0.851 (0.652 - 1.111) 0.236 Death 31 (0.3) 17 (0.2) 1.812 (1.003 - 3.273) 0.046 Laboratory Outcomes Hemoglobin 12.2 (1.9) 12.3 (1.9) N/A 0.034 Hematocrit 37.1 (6.1) 37.0 (7.0) N/A 0.518 HR, hazard ratio; PJI, prosthetic joint infection; GI, gastrointestinal; DVT, deep venous thrombosis PE, pulmonary embolism; MI, myocardial infarction Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 29 Apr, 2026 Read the published version in Archives of Orthopaedic and Trauma Surgery → Version 1 posted Editorial decision: Revision requested 11 Jan, 2026 Reviews received at journal 10 Jan, 2026 Reviewers agreed at journal 14 Dec, 2025 Reviewers agreed at journal 15 Sep, 2025 Reviews received at journal 21 Aug, 2025 Reviewers agreed at journal 21 Aug, 2025 Reviewers invited by journal 21 Aug, 2025 Editor assigned by journal 12 Aug, 2025 Submission checks completed at journal 12 Aug, 2025 First submitted to journal 04 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7294844","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":503828789,"identity":"b15ed4d1-24e3-4597-8aa5-5c1808c5e580","order_by":0,"name":"Akhil Katakam","email":"","orcid":"","institution":"Rutgers Health New Jersey Medical School","correspondingAuthor":false,"prefix":"","firstName":"Akhil","middleName":"","lastName":"Katakam","suffix":""},{"id":503828790,"identity":"526d2949-4f06-40f4-8e39-a80945b36b0d","order_by":1,"name":"Tej Joshi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYHCCBAYJIMHG3gBkG1gQVs8D18JzAKRFgigtMKsSQDQRWuzZG549sKioy+OTfH51w48CCQb+9u4E/LbwHEg3kDhzuJhNOqfsZg/QYRJnzm7Ar0UiIU1Csu1AYpt0TtoNHqAWA4lcAlrkH4C01CW2SZ5Ju/mHKC0SDCAtzIltEuzHbhNny5kEsF8S23hy2G7LGEjwEPQLe/uZtMcSFXWJ89uPP7v55o+NHH97L34tQHvSmCGRwWMAJgkoB9tzjPEDhPGACNWjYBSMglEwEgEAku1DtutfpnoAAAAASUVORK5CYII=","orcid":"","institution":"Rutgers Health New Jersey Medical School","correspondingAuthor":true,"prefix":"","firstName":"Tej","middleName":"","lastName":"Joshi","suffix":""},{"id":503828791,"identity":"88c061e6-64e5-4e31-b013-06287717c3e0","order_by":2,"name":"Thomas Soussou","email":"","orcid":"","institution":"Rutgers Health New Jersey Medical School","correspondingAuthor":false,"prefix":"","firstName":"Thomas","middleName":"","lastName":"Soussou","suffix":""},{"id":503828792,"identity":"ab4e33e2-c22b-4162-9e2a-ebbe539a236c","order_by":3,"name":"Francis Sirch","email":"","orcid":"","institution":"Monmouth Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Francis","middleName":"","lastName":"Sirch","suffix":""},{"id":503828793,"identity":"3b1581fd-3699-4e4b-a6b1-7b6e5e4af80d","order_by":4,"name":"Daniella Ogilvie","email":"","orcid":"","institution":"Rutgers Health New Jersey Medical School","correspondingAuthor":false,"prefix":"","firstName":"Daniella","middleName":"","lastName":"Ogilvie","suffix":""},{"id":503828794,"identity":"e718fa07-de7a-40b1-ad2e-2d182c58ae89","order_by":5,"name":"Tuckerman Jones","email":"","orcid":"","institution":"Rutgers Health New Jersey Medical School","correspondingAuthor":false,"prefix":"","firstName":"Tuckerman","middleName":"","lastName":"Jones","suffix":""},{"id":503828795,"identity":"1999f008-d5d1-4642-bdbb-e013a6db401a","order_by":6,"name":"Teren Yedikian","email":"","orcid":"","institution":"Rutgers Health New Jersey Medical School","correspondingAuthor":false,"prefix":"","firstName":"Teren","middleName":"","lastName":"Yedikian","suffix":""},{"id":503828796,"identity":"e8366cda-9f41-4c4b-a9b2-c24a002f9c80","order_by":7,"name":"John Erickson","email":"","orcid":"","institution":"Overlook Medical Center","correspondingAuthor":false,"prefix":"","firstName":"John","middleName":"","lastName":"Erickson","suffix":""}],"badges":[],"createdAt":"2025-08-04 23:38:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7294844/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7294844/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00402-026-06291-7","type":"published","date":"2026-04-29T15:58:17+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":108437679,"identity":"ab5b396c-63b6-49d6-83f4-cd46539228da","added_by":"auto","created_at":"2026-05-04 16:02:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":448470,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7294844/v1/f3549059-513d-40a0-a89e-3ed44f144972.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Venous Thromboembolism Prophylaxis in Total Shoulder Arthroplasty: A Matched Cohort Analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eVenous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a morbid and potentially fatal complication following total shoulder arthroplasty (TSA). Reported incidences range widely from 0.2\u0026ndash;16%, with larger database studies reporting a VTE incidence of 0.24 to 0.68%.[16; 17; 21] However, the potentially severe consequences of undiagnosed or untreated VTE, including patient mortality, highlight the importance of effective prevention strategies.[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] Additionally, by 2030, the demand for shoulder arthroplasty is projected to increase eightfold among all patients and sevenfold among those over 55, compared to levels over a decade earlier.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] This demonstrates the need for a consensus on optimal VTE prophylaxis strategies to accommodate the rising number of procedures while ensuring patient safety.\u003c/p\u003e\u003cp\u003eThe risk of VTE after TSA is multifactorial and influenced by multiple patient and procedure-specific factors. Conditions such as hypoalbuminemia, extended hospital stays, older age, African American ethnicity, and fracture-related indications for surgery have all been linked to elevated VTE risk.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] However, the utility of standardized chemical or mechanical prophylaxis in addressing these risks remains inadequately defined. The American Academy of Orthopaedic Surgeons (AAOS) does not have strict guidelines on the use of chemical prophylaxis on patients undergoing TSA and recommends an individual patient risk assessment.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] VTE prophylaxis has been well-defined in lower extremity arthroplasty, but has not yet carried over to TSA.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] The use of agents like aspirin and direct factor Xa inhibitors has increased in recent years, but their comparative effectiveness and safety profiles in TSA populations are not well-established.[1; 9]\u003c/p\u003e\u003cp\u003e One study looked at VTE before and after implementation of the 2007 National Institute for Health and Clinical Excellence (NICE) guidelines on patients undergoing upper extremity surgery. [8; 12] These guidelines recommended the use of low molecular weight heparin (LMWH) for the length of the hospital stay in patients over the age of 60, those who were obese, those who had operations longer than 90 minutes, and those with significant co-morbidities. Regarding TSA, they found no significant decrease in VTE and concluded that the use of chemoprophylaxis did not decrease VTE risk. This study was limited, however, in only examining LMWH as a chemoprophylactic agent.\u003c/p\u003e\u003cp\u003eTherefore, this study compares outcomes among patients who underwent TSA with and without standardized VTE prophylaxis, looking at any chemoprophylactic agent. We aim to assess the incidence of VTE, bleeding events, and related outcomes within the 90-day postoperative period.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData Source and Study Population\u003c/h2\u003e\u003cp\u003eA retrospective cohort study design was used to determine all patients who underwent TSA with a minimum follow up of 3 months utilizing the TriNetX database. These patients were isolated utilizing CPT 23472 with any subsequent follow at 3 months postoperative. Patients were then excluded if they had any prior history of PE or DVT within 5 years of the index TSA, as well as, any patients who was received anticoagulation within 30 days of the TSA.\u003c/p\u003e\u003cp\u003eAll data is in the TriNetX database is organized based on the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), Current Procedural Terminology (CPT), and prescription data. Because the database contains deidentified data and patient records, Institutional Review Board approval was not required.\u003c/p\u003e\u003cp\u003eOnce this initial cohort of patients was established, they were stratified into two separate cohorts. Those who received DVT prophylaxis in the form of enoxaparin, argatroban, rivaroxaban, fondaparinux, apixaban, dabigatran, aspirin, or warfarin, and those who did not. This was identified utilizing associated RXNorm codes for the respective medications.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePropensity Matching\u003c/h3\u003e\n\u003cp\u003eThe TriNetX platform allows propensity matching in a 1:1 ratio, employing logistic regression. The platform uses greedy nearest-neighbor matching with a caliper of 0.1 pooled standard deviations to propensity match. In this study, propensity matching was used to balance certain potential confounding variables between the two groups. Included variables in the propensity match included demographics (age, race, sex), medical comorbidities (overweight and obesity, hypertension, ischemic heart disease, other forms of heart disease, arterial disease, coagulation defects. All variables after 1:1 propensity score matching were not significantly different between the two groups (Table I).\u003c/p\u003e\u003cp\u003e​​\u003cb\u003eOutcomes\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOutcome measures were analyzed at 30-day, 90-day, and 6-month time points. The outcomes were grouped into surgical outcomes, medical outcomes, and laboratory value outcomes. The surgical outcome includes prosthetic joint infection (PJI), revision, wound breakdown, and hematoma. Medical outcomes included head bleed, gastrointestinal (GI) bleed, respiratory bleed, deep venous thrombosis (DVT), pulmonary embolism (PE), ischemic stroke, myocardial infarction (MI), and death. Available laboratory outcomes included hemoglobin and hematocrit. All outcomes were identified with ICD-10-CM codes or CPT codes\u003c/p\u003e\u003cp\u003eFor patient protection and confidentiality, TriNetX reports any categorical outcomes with less than 10 patients as 10 in the risk calculation. Results were reported with hazard ratio (HR), 95% confidence intervals (CI), and associated p values with Kaplan-Meier survical analysis. For continuous variables, T-test was performed. The significance threshold for all results was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAfter the initial query on January 2, 2025, to include patients who had surgery at least 3 month follow up, 11,719 patients who received DVT prophylaxis and 10,505 patients who did not receive DVT prophylaxis were identified. After 1:1 propensity score matching, 9,859 were established in each cohort for analysis.\u003c/p\u003e\n\u003ch3\u003eSurgical Outcomes\u003c/h3\u003e\n\u003cp\u003eAt all time points, there was no significant difference in risk of PJI, revision, wound breakdown, or hematoma between the patients who received DVT prophylaxis and those who did not. The overall risk of hematoma at 30 and 90 days was 0.2% and 0.3%, respectively, for both cohorts.\u003c/p\u003e\n\u003ch3\u003eMedical Outcomes\u003c/h3\u003e\n\u003cp\u003eAt 30 days, patients receiving DVT prophylaxis had a 0.539 times lower risk of subsequent ischemic stroke (95% CI 0.367\u0026ndash;0.793, p\u0026thinsp;=\u0026thinsp;0.001). Likewise, at 30 days, those patients were at 0.469 times lower risk of MI (95% CI 0.306\u0026ndash;0.718, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). At 90 days, there was no significant difference between the risk of ischemic stroke between the two groups. However, those who received DVT prophylaxis continued to have a significantly decreased risk of MI (HR 0.720, 95% CI .519\u0026ndash;0.997, p\u0026thinsp;=\u0026thinsp;0.047).\u003c/p\u003e\u003cp\u003eAt all time points, the use of DVT prophylaxis did not decrease the risk of DVT or PE. However, at 6 months, patients who received DVT prophylaxis were at 1.812 higher times the risk of death (95% CI 1.003\u0026ndash;3.273, p\u0026thinsp;=\u0026thinsp;0.046).\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eLaboratory Values\u003c/h2\u003e\u003cp\u003eAt 30 days (11.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7 versus 11.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7, p\u0026thinsp;=\u0026thinsp;0.011) and 6 months (12.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9 versus 12.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9, p\u0026thinsp;=\u0026thinsp;0.034), hemoglobin values were statistically lower among the DVT prophylaxis cohort. There was no difference of hematocrit values at any time point between the two groups.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study evaluated medical and surgical complications in patients undergoing total shoulder arthroplasty, comparing those who received venous thromboembolism prophylaxis with those who did not. No significant differences between groups regarding postoperative deep vein thrombosis, pulmonary embolism or surgical complications such as prosthetic joint infection revision surgery, wound breakdown, and hematoma formation at both 30 and 90 days were found. However, patients receiving prophylaxis had reduced rates of ischemic stroke and myocardial infarction within the first 30 days. The protective effect against ischemic stroke was found to be temporary, but the decreased risk of MI persisted at 90 days. Unexpectedly, an increase in 6-month mortality was observed in those who received VTE prophylaxis. These findings highlight the complexity of VTE prophylaxis decision-making when evaluating its use in total shoulder arthroplasty.\u003c/p\u003e\u003cp\u003eThe incidence of VTE and PE in our study is consistent with past literature and suggests that clinically significant VTE following TSA is rare.[6; 10; 12; 21] Rates of symptomatic DVT and PE following TSA are typically reported between 0.2% and 2% in large-scale studies; however, observational data suggest the true incidence may be higher in patients with specific comorbidities.[6; 10; 12; 16; 21] Additionally, true incidence rates may be much higher if asymptomatic cases are included which often go undetected without routine imaging.[6; 10; 12; 16; 21] The role of thromboprophylaxis in shoulder arthroplasty remains debated. Hole et al. reviewed the Norwegian arthroplasty registry and reported no significant association between thromboprophylaxis use and postoperative mortality.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] Kolz et al. identified advanced age and traumatic indications as significant risk factors for VTE and recommended prophylaxis primarily for patients with multiple risk factors, such as active malignancy, previous VTE, or coagulopathy.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] Lung et al. corroborated the significance of elderly age and identified African American ethnicity as an additional risk factor, though obesity, smoking, malignancy, and operative time were not associated with increased VTE risk.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] Conversely, Zhang et al.. reported that advanced age, higher BMI, and prolonged operative durations were associated with higher risks of both DVT and PE.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] While these studies provide insight into risk stratification, they offer limited evaluation of whether prophylaxis meaningfully reduces medical or surgical complications. Moreover, the mortality benefit associated with VTE prophylaxis remains unclear, as evidenced by Hole et al. and Jameson et al.\u0026rsquo;s 2011 study, which found no improvement in mortality following the implementation of low molecular weight heparin after the 2007 NICE guidelines.[6; 8] As these studies were limited to LMWH, the broader impact of chemoprophylaxis on postoperative outcomes remains unclear.\u003c/p\u003e\u003cp\u003eOur findings showed no significant difference in symptomatic DVT or PE rates between patients who received chemoprophylaxis and those who did not, supporting the low overall risk of VTE in the general TSA population. However, observed reductions in 30-day ischemic stroke and 90-day MI rates suggest potential supplementary benefits of VTE prophylactic agents, such as aspirin and direct oral anticoagulants (DOACs), that extend beyond VTE prevention.\u003c/p\u003e\u003cp\u003eHistorically, VTE risk has been linked to Virchow\u0026rsquo;s triad: intimal injury, hypercoagulability, and venous stasis. Specific to TSA, additional intraoperative risk factors include extreme humeral positioning, sharp retractors causing micro injury to vessel walls, compression of the axillary vessels by retractors, and cement-associated hypercoagulability.[16; 19] Intraoperatively, patients are often positioned in the beach chair setup, which may promote femoral vein stasis due to prolonged hip flexion, compounded by postoperative immobilization in a sling.[16; 19]\u003c/p\u003e\u003cp\u003eTwo of the most common agents used for VTE prophylaxis are aspirin and DOACs such as apixaban, rivaroxaban, and dabigatran. Aspirin irreversibly inhibits COX-1 and platelet aggregation, making it effective in preventing arterial thrombotic events including MI and stroke.[4; 13; 14] DOACs, which inhibit factor Xa or thrombin, reduce venous thrombosis via inhibition of fibrin formation, but may also reduce arterial thrombosis by limiting thrombin-mediated platelet activation.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] In orthopedic surgery patient populations, aspirin has shown effectiveness in reducing VTE risk following total joint arthroplasty and may reduce stroke risk after TSA.[4; 13; 14] Our findings suggest that aspirin pharmacologic VTE prophylaxis may confer protection against arterial thrombosis, while having limited observable impact on venous thromboses.[2; 13; 18] This discrepancy can be explained by differences in thrombosis biology. Arterial clots are driven by platelet aggregation and are effectively suppressed by the aspirin-based regimens, whereas venous clots are fibrin driven and are likely infrequent or subclinical to appreciably a clinically observable decrease. Additionally, asymptomatic venous clots likely go undetected in routine clinical care, which may obscure any potential benefit of prophylaxis. Prophylaxis reduces platelet-mediated complications through its antiplatelet and anticoagulant effects. However, the low baseline risk of symptomatic VTE following TSA limits the ability to detect a clinically significant reduction. Future research should focus on better detecting silent VTE to see they may confer additional previous undetected risks, refining prophylaxis choices, and confirming outcomes of specific anticoagulants in prospective trials.\u003c/p\u003e\u003cp\u003eOur study found an increase in 6-month mortality among patients receiving prophylaxis. This finding should be interpreted with caution due to several confounding factors. While certain anticoagulants may be associated with delayed adverse events, including gastrointestinal bleeding, hemorrhagic stroke, or other complications that could contribute to late mortality, it is more likely that patients who necessitated VTE prophylaxis had underlying risk factors that were unable to be adequately matched within our dataset and conferred a higher baseline mortality risk. Additionally, variability in arthroplasty type, surgical indications such as fracture or rheumatoid arthritis, and other clinical complexities may not be fully captured in the TriNetX dataset. DVT and PE events were identified based on documented clinical coding, which are typically documented only in symptomatic patients. Additionally, we were unable to account for patient frailty, and mobility status which are prone to influence both the decision to prescribe prophylaxis and patient outcomes. Unmeasured confounders such as genetic predisposition, socioeconomic status, and the use of concurrent medications like tamoxifen or hormone therapy may also contribute to residual bias. A lack of data on the duration, frequency, and limited stratified analysis of specific prophylaxis agent used further complicate interpretation due to differences in risk profiles of medications and mechanisms of action. These limitations emphasize the need for prospective, risk-stratified studies that capture detailed treatment regimens. These future studies will be critical to better understanding the relationship between VTE prophylaxis and late mortality and refining postoperative protocols in shoulder arthroplasty.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eChemical 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 absence of a reduction in VTE and the observed increase in 6-month mortality raise concerns about the universal application of prophylaxis and suggest that a more individualized, risk-based approach is warranted beyond what has been described in previous literature. Our findings emphasize the need for high-quality, prospective studies to guide agent selection, prophylaxis duration, and appropriate patient selection, ultimately helping optimize postoperative care and patient safety in the shoulder arthroplasty population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAK, TJ, TS, FS, DO, TJ, TY, and JE contributed to the conceptualization, methodology, data collection, validation, writing\u0026mdash;original draft preparation, and writing\u0026mdash;review and editing of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAgarwal AR, Ahmed AF, Stadecker M, Miller AS, Best MJ, Srikumaran U (2023) Trends in Venous Thromboembolism After Shoulder Arthroplasty in the United States: Analysis Following the 2009 American Academy of Orthopaedic Surgeons Clinical Practical Guidelines. J Am Acad Orthop Surg 31(7):364\u0026ndash;372\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBecattini C, Agnelli G, Schenone A et al (2012) Aspirin for preventing the recurrence of venous thromboembolism. N Engl J Med 366(21):1959\u0026ndash;1967\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChiarito M, Cao D, Cannata F et al (2018) Direct Oral Anticoagulants in Addition to Antiplatelet Therapy for Secondary Prevention After Acute Coronary Syndromes: A Systematic Review and Meta-analysis. JAMA Cardiol 3(3):234\u0026ndash;241\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDrescher FS, Sirovich BE, Lee A, Morrison DH, Chiang WH, Larson RJ (2014) Aspirin versus anticoagulation for prevention of venous thromboembolism major lower extremity orthopedic surgery: a systematic review and meta-analysis. J Hosp Med 9(9):579\u0026ndash;585\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFalck-Ytter Y, Francis CW, Johanson NA et al (2012) Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 141(2 Suppl):e278S-e325S\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHole RM, Fenstad AM, Gjertsen JE, Lie SA, Furnes O (2021) Thromboprophylaxis in primary shoulder arthroplasty does not seem to prevent death: a report from the Norwegian Arthroplasty Register 2005\u0026ndash;2018. Acta Orthop 92(4):401\u0026ndash;407\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eIzquierdo R, Voloshin I, Edwards S et al (2010) Treatment of glenohumeral osteoarthritis. J Am Acad Orthop Surg 18(6):375\u0026ndash;382\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJameson SS, James P, Howcroft DW et al (2011) Venous thromboembolic events are rare after shoulder surgery: analysis of a national database. J Shoulder Elb Surg 20(5):764\u0026ndash;770\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKirsch JM, Gutman M, Patel M et al (2021) Low-dose aspirin and the rate of symptomatic venous thromboembolic complications following primary shoulder arthroplasty. J Shoulder Elb Surg 30(7):1613\u0026ndash;1618\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKolz JM, Aibinder WR, Adams RA, Cofield RH, Sperling JW (2019) Symptomatic Thromboembolic Complications After Shoulder Arthroplasty: An Update. J Bone Joint Surg Am 101(20):1845\u0026ndash;1851\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLung BE, Kanjiya S, Bisogno M, Komatsu DE, Wang ED (2019) Risk factors for venous thromboembolism in total shoulder arthroplasty. JSES Open Access 3(3):183\u0026ndash;188\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMancini MR, LeVasseur MR, Hawthorne BC, Marrero DE, Mazzocca AD (2021) Venous thromboembolism complications in shoulder surgery: current concepts. J ISAKOS 6(5):283\u0026ndash;289\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMao X, Liang C, Li X et al (2023) The impact of long-term aspirin use on the patients undergoing shoulder arthroplasty. J Orthop Surg Res 18(1):894\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMatharu GS, Kunutsor SK, Judge A, Blom AW, Whitehouse MR (2020) Clinical Effectiveness and Safety of Aspirin for Venous Thromboembolism Prophylaxis After Total Hip and Knee Replacement: A Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA Intern Med 180(3):376\u0026ndash;384\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePadegimas EM, Maltenfort M, Lazarus MD, Ramsey ML, Williams GR, Namdari S (2015) Future patient demand for shoulder arthroplasty by younger patients: national projections. Clin Orthop Relat Res 473(6):1860\u0026ndash;1867\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRapp CM, Shields EJ, Wiater BP, Wiater JM (2019) Venous Thromboembolism After Shoulder Arthoplasty and Arthroscopy. J Am Acad Orthop Surg 27(8):265\u0026ndash;274\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSaleh HE, Pennings AL, ElMaraghy AW (2013) Venous thromboembolism after shoulder arthroplasty: a systematic review. J Shoulder Elb Surg 22(10):1440\u0026ndash;1448\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWarkentin TE (2012) Aspirin for dual prevention of venous and arterial thrombosis. N Engl J Med 367(21):2039\u0026ndash;2041\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWillis AA, Warren RF, Craig EV et al (2009) Deep vein thrombosis after reconstructive shoulder arthroplasty: a prospective observational study. J Shoulder Elb Surg 18(1):100\u0026ndash;106\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYoung BL, Menendez ME, Baker DK, Ponce BA (2015) Factors associated with in-hospital pulmonary embolism after shoulder arthroplasty. J Shoulder Elb Surg 24(10):e271\u0026ndash;278\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang D, Dyer GSM, Earp BE (2022) Venous Thromboembolism After Total Shoulder Arthroplasty: A Database Study of 31,918 Cases. J Am Acad Orthop Surg 30(19):949\u0026ndash;956\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"102%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable I\u003c/strong\u003e Propensity matching criteria for patients with and without DVT prophylaxis after total shoulder arthroplasty\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBefore Matching\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAfter Matching\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 21px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDVT PPx (n=11,719)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo DVT PPx (n=10,505)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDVT PPx (n=9,859)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo DVT PPx (n=9,859)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 21px;\"\u003e\n \u003cp\u003eAge (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e69.4 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e68.7 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e69.0 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e69.0 (8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.529\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 21px;\"\u003e\n \u003cp\u003eSex, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e4786 (40.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e4651 (44.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e4304 (43.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e4314 (43.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.886\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e5976 (51.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e5569 (53.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e5269 (53.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e5260 (53.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.898\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e957 (8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e285 (2.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e286 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e285 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.966\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 21px;\"\u003e\n \u003cp\u003eRace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eAmerican Indian or Alaska Native\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e24 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e23 (0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.819\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e20 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e23 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.647\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eAsian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e80 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e178 (1.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e80 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e76 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.748\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eBlack or African American\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e555 (4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e628 (5.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e539 (5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e528 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.729\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eNative Hawaiian or Other Pacific Islander\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e13 (0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e40 (0.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e13 (0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e13 (0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e9450 (80.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e8465 (80.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.914\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e8293 (84.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e8336 (84.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.400\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eOther Race\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e174 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e310 (2.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e169 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e160 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.617\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eUnknown Race\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e1423 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e861 (8.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e745 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e723 (7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.551\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 21px;\"\u003e\n \u003cp\u003eCommodities, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eCoagulation Defects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e743 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e662 (6.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.907\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e604 (6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e626 (6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.517\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eArterial Diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e2227 (19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e1941 (18.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e1802 (18.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e1856 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.323\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eIschemic Heart Disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e2619 (22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e2076 (19.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e1976 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e2019 (20.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.446\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eOther Hear Disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e4277 (36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e3297 (31.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e3272 (33.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e3228 (32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.505\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eOverweight and obesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e4624 (39.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e3648 (34.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e3603 (36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e3566 (36.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.584\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 0px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e8029 (68.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e6745 (64.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e6499 (65.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e6462 (65.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e0.579\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cem\u003eDVT, deep venous thrombosis; PPx, prophylaxis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable II\u0026nbsp;\u003c/strong\u003eSurvival analysis at 30 days for patients with and without DVT prophylaxis after total shoulder arthroplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDVT PPx (n=9,859)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo DVT PPx (n=9,859)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 22px;\"\u003e\n \u003cp\u003eSurgical Outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003ePJI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e49 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e50 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e0.981 (0.661 - 1.454)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.922\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eRevision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e45 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e48 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e0.938 (0.625 - 1.409)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.758\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eWound Breakdown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e14 (0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e19 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e0.737 (0.369 - 1.470)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.384\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eHematoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e16 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e22 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e0.728 (0.382 - 1.385)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.331\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 22px;\"\u003e\n \u003cp\u003eMedical Outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eHead Bleed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e10 (0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e10 (0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e0.600 (0.143 - 2.511)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eGI Bleed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e34 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e37 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e0.919 (0.577 - 1.464)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.722\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eRespiratory Bleed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e10 (0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e10 (0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e1.286 (0.479 - 3.454)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.616\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eDVT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e55 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e53 (0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e1.039 (0.712 - 1.515)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.843\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003ePE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e19 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e21 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e0.905 (0.487 - 1.684)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.753\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eIschemic Stroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e40 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e74 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e0.539 (0.367 - 0.793)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e31 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e66 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e0.469 (0.306 - 0.718)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eDeath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e10 (0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e10 (0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 22px;\"\u003e\n \u003cp\u003eLaboratory Outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eHemoglobin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e11.3 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e11.4 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eHematocrit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e34.4 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e34.3 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.768\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cem\u003eHR, hazard ratio; PJI, prosthetic joint infection; GI, gastrointestinal; DVT, deep venous thrombosis PE, pulmonary embolism; MI, myocardial infarction\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable III\u0026nbsp;\u003c/strong\u003eSurvival analysis at 90 days for patients with and without DVT prophylaxis after total shoulder arthroplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDVT PPx (n=9,859)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo DVT PPx (n=9,859)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 22px;\"\u003e\n \u003cp\u003eSurgical Outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003ePJI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e79 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e88 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.898 (0.663 - 1.217)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.488\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eRevision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e105 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e100 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1.051 (0.799 - 1.382)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.721\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eWound Breakdown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e29 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e39 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.744 (0.460 - 1.203)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.226\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eHematoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e25 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e29 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.862 (0.505 - 1.472)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.587\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 22px;\"\u003e\n \u003cp\u003eMedical Outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eHead Bleed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e10 (0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e13 (0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.770 (0.338 - 1.756)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.533\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eGI Bleed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e63 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e69 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.913 (0.649 - 1.285)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.692\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eRespiratory Bleed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e23 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e18 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1.279 (0.690 - 2.371)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.432\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eDVT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e78 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e76 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1.028 (0.749 - 1.409)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.866\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003ePE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e28 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e32 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.876 (0.527 - 1.454)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.608\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eIschemic Stroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e81 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e105 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.770 (0.576 - 1.029)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e62 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e86 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.720 (0.519 - 0.997)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eDeath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e10 (0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e10 (0.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1.335 (0.299 - 5.964)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.704\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 22px;\"\u003e\n \u003cp\u003eLaboratory Outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eHemoglobin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e11.8 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e11.9 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eHematocrit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e35.8 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e35.7 (6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cem\u003eHR, hazard ratio; PJI, prosthetic joint infection; GI, gastrointestinal; DVT, deep venous thrombosis PE, pulmonary embolism; MI, myocardial infarction\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable IV\u0026nbsp;\u003c/strong\u003eSurvival analysis at 6 months for patients with and without DVT prophylaxis after total shoulder arthroplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 22px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDVT PPx (n=9,859)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo DVT PPx (n=9,859)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 22px;\"\u003e\n \u003cp\u003eSurgical Outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003ePJI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e104 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e111 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.935 (0.716 - 1.222)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.624\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eRevision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e156 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e156 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.999 (0.800 - 1.247)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.993\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eWound Breakdown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e40 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e44 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.908 (0.592 - 1.394)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.659\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eHematoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e32 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e36 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.888 (0.551 - 1.429)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.624\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 22px;\"\u003e\n \u003cp\u003eMedical Outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eHead Bleed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e16 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e21 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.760 (0.397 - 1.457)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.408\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eGI Bleed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e93 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e97 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.957 (0.720 - 1.271)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eRespiratory Bleed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e37 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e34 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1.086 (0.682 - 1.730)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.728\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eDVT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e97 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e94 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1.031 (0.777 - 1.370)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.831\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003ePE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e39 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e38 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1.025 (0.656 - 1.603)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.912\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eIschemic Stroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e111 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e139 (1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.795 (0.620 - 1.021)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e100 (1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e117 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.851 (0.652 - 1.111)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.236\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eDeath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e31 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e17 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1.812 (1.003 - 3.273)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 22px;\"\u003e\n \u003cp\u003eLaboratory Outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eHemoglobin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e12.2 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e12.3 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 2px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003eHematocrit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e37.1 (6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003e37.0 (7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003eN/A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.518\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cem\u003eHR, hazard ratio; PJI, prosthetic joint infection; GI, gastrointestinal; DVT, deep venous thrombosis PE, pulmonary embolism; MI, myocardial infarction\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-orthopaedic-and-trauma-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aots","sideBox":"Learn more about [Archives of Orthopaedic and Trauma Surgery](http://link.springer.com/journal/402)","snPcode":"402","submissionUrl":"https://submission.springernature.com/new-submission/402/3","title":"Archives of Orthopaedic and Trauma Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"DVT prophylaxis, Total Shoulder Arthroplasty, TriNetX, Bleeding Risk, Pulmonary Embolism, DVT, PE","lastPublishedDoi":"10.21203/rs.3.rs-7294844/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7294844/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods: \u003c/strong\u003eA 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAfter 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; \u003cem\u003ep\u003c/em\u003e = 0.001) and myocardial infarction (MI) at both 30 days (HR 0.469; 95% CI 0.306–0.718; \u003cem\u003ep\u003c/em\u003e\u0026lt; 0.001) and 90 days (HR 0.720; 95% CI 0.519–0.997; \u003cem\u003ep\u003c/em\u003e = 0.047). However, at 6 months, patients with prophylaxis demonstrated an increased risk of mortality (HR 1.812; 95% CI 1.003–3.273; \u003cem\u003ep\u003c/em\u003e = 0.046).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eChemical 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLevel of evidence: \u003c/strong\u003eLevel III Retrospective Cohort Comparison Using Large Database Prognosis Study\u003c/p\u003e","manuscriptTitle":"Venous Thromboembolism Prophylaxis in Total Shoulder Arthroplasty: A Matched Cohort Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-31 16:43:43","doi":"10.21203/rs.3.rs-7294844/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-11T09:03:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-11T04:39:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"137656055948270600149801404480016821137","date":"2025-12-14T05:21:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"320419888712258391295501795747605087582","date":"2025-09-15T05:24:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-21T18:22:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"62258318361945780691192731003714706116","date":"2025-08-21T18:11:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-21T18:07:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-12T09:47:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-12T09:44:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Orthopaedic and Trauma Surgery","date":"2025-08-04T23:27:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-orthopaedic-and-trauma-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aots","sideBox":"Learn more about [Archives of Orthopaedic and Trauma Surgery](http://link.springer.com/journal/402)","snPcode":"402","submissionUrl":"https://submission.springernature.com/new-submission/402/3","title":"Archives of Orthopaedic and Trauma Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"972b88c9-eb67-4446-8b5c-0735b10b1792","owner":[],"postedDate":"August 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T16:00:43+00:00","versionOfRecord":{"articleIdentity":"rs-7294844","link":"https://doi.org/10.1007/s00402-026-06291-7","journal":{"identity":"archives-of-orthopaedic-and-trauma-surgery","isVorOnly":false,"title":"Archives of Orthopaedic and Trauma Surgery"},"publishedOn":"2026-04-29 15:58:17","publishedOnDateReadable":"April 29th, 2026"},"versionCreatedAt":"2025-08-31 16:43:43","video":"","vorDoi":"10.1007/s00402-026-06291-7","vorDoiUrl":"https://doi.org/10.1007/s00402-026-06291-7","workflowStages":[]},"version":"v1","identity":"rs-7294844","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7294844","identity":"rs-7294844","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}