A review of the evidence for and against thromboprophylaxis in total hip replacement (original) (raw)
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Journal of Vascular Surgery, 1999
Purpose: The purpose of this study was to assess the rate of postoperative deep vein thrombosis (DVT) as a function of oral anticoagulation therapy after total hip replacement surgery. Methods: A total of 125 patients completed the study. All the patients received sequential gradient pneumatic compression over elastic stockings until hospital discharge. In addition, all the patients underwent postoperative heparin therapy followed by oral warfarin therapy, adjusted in dose to maintain a goal international normalized ratio (INR) level of 2.0 to 3.0. Warfarin therapy and compression stockings were continued for 1 month after surgery. Bilateral duplex scanning was performed 1 and 4 weeks after surgery to assess the rate of DVT.
Clinical and Applied Thrombosis/Hemostasis, 2019
The risk of thromboembolic events after hip revision arthroplasty might be higher than in primary hip arthroplasty. However, evidence regarding the use of thromboprophylaxis in revisions is scarce. The purpose of this study is to determine whether thromboprophylaxis recommendations for primary arthroplasty produce similar results in hip revision arthroplasty. This comparative cohort study retrospectively analyzed consecutive patients undergoing primary hip arthroplasty and hip revision surgery between March 2004 and December 2015, who received thromboprophylaxis according to local clinical practice guidelines for primary hip arthroplasty. The prevalence of deep vein thrombosis and pulmonary embolism and the presence of major bleeding events were assessed during hospitalization and at 3 months after discharge and compared between groups. The overall prevalence of thromboembolic events in the hip revision surgery cohort and in the primary hip cohort was 1.62% and 1.35%, respectively (...
Thromboprophylaxis and death after total hip replacement
The Journal of Bone and Joint Surgery, 1996
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. REFERENCES * references not used in the meta-analysis Alfaro MJ, Paramo JA, Rocha E. Prophylaxis of thromboembolic disease and platelet-related changes following total hip replacement: a comparative study of aspirin and heparin-dihydroergotamine. Thromb Haemost 1986;56:53-6. Alexander JP, Barron DW. Clinical considerations in anaesthesia for hip arthroplasty. Anaesthesia 1978;33:748-51. Alexander JP, Barron DW. The effect of alcohol on the pulmonary embolic syndrome. Anaesthesia 1980;35:506-8. Amstutz HC, Friscia DA, Dorey F, Carney BT. Warfarin prophylaxis to prevent mortality from pulmonary embolism after total hip replacement. J Bone Joint Surg [Am] 1989;71-A:321-6. *APT. Antiplatelet Trialists' Collaboration. Collaborative overview of randomised trials of antiplatelet therapy-i: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Br Med J 1994a;308:81-106. *APT. Antiplatelet Trialists Collaboration. Collaborative overview of randomised trials of antiplatelet therapy-iii: reduction in venous thrombosis and pulmonary embolism by antiplatelet prophylaxis among surgical and medical patients. Br Med J 1994b;308:235-46. Arborelius M, Fredin H, Nyman U, Hellekant C. Angiographic evaluation of scintigraphic abnormalities in screening for pulmonary embo
Thromboembolic complications after total hip replacement
International Orthopaedics, 2002
We conducted a retrospective analysis of 1,640 consecutive patients undergoing total hip replacement between 1990 and 1997 under general anesthesia and receiving three different prophylactic regimens. The thromboembolic prophylaxis consisted of low-dose unfractioned heparin (UFH), low-molecular-weight heparin (LMWH), or indobufen (INDO). Postoperatively, occurrence of symptomatic deep vein thrombosis (DVT) or pulmonary embolism (PE) was recorded during the first 30 days after surgery and at a routine follow-up visit. Symptomatic DVT was diagnosed in 16 patients (0.9%), while PE occurred in eight patients (0.5%). Patients receiving UFH showed a higher incidence of symptomatic DVT (3.6%) than those patients receiving either LMWH (1.3%) or INDO (0.3%), with an odds ratio for developing symptomatic DVT when receiving UFH versus other treatments of 6.05 (95% confidence intervals [CI 95% ]: 3.63-10.07) (P=0.001). On the other hand, the diagnosis of PE was more frequently seen in patients receiving cemented hip arthroplasty (2.4%) than in patients receiving uncemented hip arthroplasty (0.34%), with an odds ratio of 3.185 (CI 95% : 2.01-5.02)(P=0.05). Resume Nous avons conduit une analyse rétrospective de 1640 patients consécutifs opérés pour arthroplastie totale de la hanche entre 1990 et 1997, sous anesthésie générale, et recevant trois régimes différents de prophylaxie thromboembolique : soit héparine fractionnée à basse dose, soit héparine de bas poids moléculaire poids moléculaire soit indobufen. Après l'intervention une thrombose profonde symptomatique ou une embolie pulmonaire a été recherchée pendant les premiers 30 jours après la chirurgie, et à une visite habituelle de routine. La thrombose veineuse profonde symptomatique a été diagnostiquée chez 16 patients (0.9%), pendant que l'embolie pulmonaire s'est produite chez 8 patients (0.5%). Les patients qui recevaient de l'héparine fractionnée ont montré une plus haute fréquence de thrombose veineuse profonde symptomatique (3.6%) que ceux patients qui recevaient de l'héparine de bas poids moléculaire (1.3%) ou de l' indobufen (0.3%), avec une majoration du risque de 6.05 (intervalle de la confiance de 95% [CI95%]: 3.63-10.07) (P= 0.001). Le diagnostic d'embolie pulmonaire a été fait plus fréquemment chez les patients qui ont eu une arthroplastie cimentée (2.4%) que chez ceux patients qui ont eu une arthroplastie noncimenté (0.34%), avec une majoration du risque de 3.185 (CI95%: 2.01-5.02) (P=0.05).
Multimodal thromboprophylaxis following primary hip arthroplasty
The Journal of Bone and Joint Surgery. British volume, 2008
We report a retrospective review of the incidence of venous thromboembolism in 463 consecutive patients who underwent primary total hip arthroplasty (487 procedures). Treatment included both total hip replacement and hip resurfacing, and the patients were managed without anticoagulants. The thromboprophylaxis regimen included an antiplatelet agent, generally aspirin, hypotensive epidural anaesthesia, elastic compression stockings and early mobilisation. In 258 of these procedures (244 patients) performed in 2005 (cohort A) mechanical compression devices were not used, whereas in 229 (219 patients) performed during 2006 (cohort B) bilateral intermittent pneumatic calf compression was used. All operations were performed through a posterior mini-incision approach. Patients who required anticoagulation for pre-existing medical problems and those undergoing revision arthroplasty were excluded. Doppler ultrasonographic screening for deep-vein thrombosis was performed in all patients betwe...
Thrombosis research, 2012
BACKGROUND: The American College of Chest Physicians (ACCP) guidelines recommends thromboprophylaxis for total hip replacement (THR) and total knee replacement (TKR) patients. We examined alignment with ACCP thromboprophylaxis guidelines among THR/TKR patients, and compared symptomatic venous thromboembolism (VTE), bleeding event rates and risk factors for VTE between patients receiving ACCP-recommended thromboprophylaxis ('ACCP') and those who did not ('non-ACCP'). METHODS: This retrospective observational study used a large US health plan claims database that was linked to an inpatient database containing detailed inpatient medication use and a database containing date-of-death information. Patients who had THR/TKR surgery between April 01, 2004 and December 31, 2006 were included. Comparisons of VTE and bleeding events between ACCP and non-ACCP patients were analyzed using chi-squared tests and multivariate logistic regression. RESULTS: Of 3,497 linked patient...
Postdischarge thromboprophylaxis and mortality risk after hip-or knee-replacement surgery
Canadian Medical Association Journal, 2008
V enous thromboembolism is a leading cause of mortality among patients in hospital. 1,2 Major orthopedic surgery (e.g., hip or knee replacement) is associated with a high risk for postoperative venous thromboembolism. 1,3,4 Because the clinical diagnosis of venous thromboembolism is unreliable and its first manifestation may be a life-threatening pulmonary embolism, 5 it is recommended that patients undergoing hip or knee replacement receive routine thromboprophylaxis with anticoagulant therapy after surgery unless they have contraindications to anticoagulant therapy. 1,3,5,6 Thromboprophylaxis is commonly administered for the entire hospital stay, which is usually between 4 and 14 days. 7 Expert consensus guidelines recommend that patients undergoing hip or knee replacement receive thromboprophylaxis medications for at least 10 days after surgery. 6 These guidelines also recommend extended thromboprophylaxis for up to 28-35 days after surgery for patients undergoing hip replacement. 6 Although there is evidence that extended thromboprophylaxis after hospital discharge is effective for reducing the risk of venous thromboembolism among patients who undergo hip replacement, 8 the benefit among patients who undergo knee replacement has not been established. 6 Thromboprophylaxis after discharge is likely to most benefit patients at high risk for venous thromboembolism,
Oral thromboprophylaxis following total hip replacement: the issue of compliance
Orthopaedics & traumatology, surgery & research : OTSR, 2012
Thirty-five to 40 days' thromboprophylaxis is recommended following total hip replacement (THR). Low molecular weight heparin (LMWH) injected by a health professional ensures good compliance. Compliance with recent oral anticoagulants has not been precisely assessed. Oral self-administration, without coagulation monitoring tests, may be a worrying issue in the management of what is a potentially catastrophic adverse event, without prodromal symptoms alerting the patient to the need for regular intake throughout the prescription period. It was hypothesized that compliance with these new oral anticoagulants is good over the entire treatment period. The present cohort study prospectively assessed compliance with oral medication (two capsules of dabigatran etexilate [Pradaxa(®)] per day in a single dose at a set time) following THR. An electronic device continuously monitored the day and time of extraction of capsules from the package. All included patients underwent clinical and ec...
HIP International, 2001
After total hip replacement, continued pharmacological prophylaxis following hospital discharge is controversial.The primary objective of our study was to determine the safety and efficacy of continued prophylaxis with nadroparin three weeks after hospital discharge. The secondary objective was to evaluate the association between a confirmed venous thromboembolism and risk factors for deep venous thrombosis.This study was an open-label, randomized, multicentre, prospective trial. Patients were evaluated for deep venous thrombosis with duplex ultrasonography at discharge and 3 weeks later. Walking ability (mobility score) was assessed at the same times. Patients without deep venous thrombosis at discharge were randomly assigned to continued nadroparin (n=155) versus no pharmacologic prophylaxis (n=141) for three weeks.The rate of deep venous thrombosis three weeks post discharge was significantly lower in the nadroparin group: two patients (1.3%) versus nine (6.4%) without prophylaxi...