1212 - Acute deep vein thrombosis after total knee arthroplasty despite prophylactic anticoagulation and extensive ambulation: A Case Report

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

KR

Keierre Richards, MD

PM&R Resident PGY-2
The Ohio State University
columbus, Ohio, United States

Co-Author(s)

EY

Eunkyung Yu, MD

Assistant Professor
Ohio State University
Columbus, Ohio, United States

Submitter(s)

KR

Keierre Richards, MD

The Ohio State University
columbus, Ohio, United States

Case Diagnosis: Acute deep vein thrombosis of the common femoral vein of the left lower extremity and posterior tibial and soleal vein of the right lower extremity.

Case Description: A 36-year-old male with prior history of heart transplant presented to inpatient rehab (IPR) after undergoing left TKA (total knee arthroplasty) for osteoarthritis on aspirin 81mg twice daily for DVT (deep vein thrombosis) prophylaxis. At IPR, the patient progressed to ambulating over 500 feet daily. During IPR, he endorsed mild left foot swelling with no DVT on lower extremity duplex ultrasound. Due to continued swelling days later, duplex ultrasound was repeated and confirmed acute DVTs within the posterior tibial and soleal veins of the right lower limb, and the common femoral vein of the left lower limb. Therapeutic Eliquis was then initiated to treat his acute DVTs.

Discussions: Acute DVT of the lower extremities can be a common complication with decreased mobility, especially following recent surgery. Due to complication risk from DVTs, chemoprophylaxis is routinely utilized after joint arthroplasty, with recent literature advocating that aspirin 81mg twice daily has comparable efficacy to other anticoagulants. Previous literature also demonstrates that increased ambulation aids DVT prevention through reduced venous stasis. Furthermore, though this patient underwent TKA, he also had a history of heart transplant, further increasing his DVT risk. Thus, while literature states that aspirin can be appropriate chemoprophylaxis after joint replacement, this case warrants reflection on if this patient’s medical history was considered when deciding which chemoprophylactic to utilize, and if a different medication may have prevented his DVTs.

Conclusions: Acute DVT while ambulating and on prophylactic anticoagulation is a rare occurrence. While anomalous, such instances emphasize the importance of an individualistic approach when considering DVT prophylaxis, especially in patients with hypercoagulable history.