ARTÍCULOS MÉDICOS

General, Rodilla

Venous thromboembolism after lower limb arthroplasty: is chemical prophylaxis still needed?

European Journal of Orthopaedic Surgery & Traumatology

December 2016, Volume 26, Issue 8, pp 895–899

Venous thromboembolism after lower limb arthroplasty: is chemical prophylaxis still needed

Karan Malhotra, Jan L. Marciniak, Sandra J. Bonczek, Neil Hunt

Abstract

Background

Venous thromboembolism (VTE) is a significant complication of lower limb arthroplasty. The National Institute for Health and Care Excellence recommends routine use of chemical and mechanical prophylaxis to prevent VTE. Our high-volume, elective, arthroplasty unit adopted this guidance in 2008.

Purpose

We examined our incidence of VTE before and after introduction of chemical thromboprophylaxis to determine whether the incidence of VTE reduced.

Methods

We retrospectively gathered data on 2 cohorts of patients—from January 2004 to August 2007 (Group 1) and January 2010 to December 2012 (Group 2). Patients in Group 1 received mechanical prophylaxis only (unless particularly high risk for VTE), and patients in Group 2 received mechanical and chemical prophylaxis. We recorded VTE occurring within 6 months of surgery. Patients in Group 1 receiving chemical prophylaxis were excluded.

Results

Group 1 had 2320 cases of primary and revision lower limb arthroplasty, and Group 2 had 1430 cases. VTE occurred in 37 cases in Group 1 (1.6 %), and in 17 cases in Group 2 (1.2 %). This difference was not statistically significant (p = 0.26). In Group 1, 1 patient died within 6 months due to pulmonary embolism (0.04 %); there were no VTE-related deaths in Group 2 (0 %). This was also not statistically significant (p = 0.06).

Conclusions

Although our VTE rate reduced by 0.4 % and our VTE-related mortality reduced by 0.04 % after introduction of chemical thromboprophylaxis, these differences were not statistically significant. Chemical thromboprophylaxis may not be required in all patients undergoing arthroplasty providing appropriate mechanical prophylaxis is used.

Keywords

Venous thromboembolismTotal hip arthroplastyTotal knee arthroplastyThromboprophylaxis

References

1.
Imperiale TF, Speroff T (1994) A meta-analysis of methods to prevent venous thromboembolism following total hip replacement. JAMA 271:1780–1785CrossRefGoogle Scholar
2.
Warwick D, Williams MH, Bannister GC (1995) Death and thromboembolic disease after total hip replacement. A series of 1162 cases with no routine chemical prophylaxis. J Bone Joint Surg Br 77:6–10Google Scholar
3.
Howie C, Hughes H, Watts AC (2005) Venous thromboembolism associated with hip and knee replacement over a ten-year period: a population-based study. J Bone Joint Surg Br 87:1675–1680. doi:10.1302/0301-620X.87B12.16298CrossRefGoogle Scholar
4.
Strebel N, Prins M, Agnelli G, Buller HR (2002) Preoperative or postoperative start of prophylaxis for venous thromboembolism with low-molecular-weight heparin in elective hip surgery? Arch Intern Med 162:1451–1456CrossRefGoogle Scholar
5.
NICE (2010) Venous thromboembolism: reducing the risk for patients in hospital.https://www.nice.org.uk/guidance/cg92. Accessed 20 Jan 2016
6.
Jameson SS, Bottle A, Malviya A, Muller SD, Reed MR (2010) The impact of national guidelines for the prophylaxis of venous thromboembolism on the complications of arthroplasty of the lower limb. J Bone Joint Surg Br 92:123–129. doi:10.1302/0301-620X.92B1.22751CrossRefGoogle Scholar
7.
Colwell CW Jr, Froimson MI, Mont MA, Ritter MA, Trousdale RT, Buehler KC, Spitzer A, Donaldson TK, Padgett DE (2010) Thrombosis prevention after total hip arthroplasty: a prospective, randomized trial comparing a mobile compression device with low-molecular-weight heparin. J Bone Joint Surg Am 92:527–535. doi:10.2106/JBJS.I.00047CrossRefGoogle Scholar
8.
Yokote R, Matsubara M, Hirasawa N, Hagio S, Ishii K, Takata C (2011) Is routine chemical thromboprophylaxis after total hip replacement really necessary in a Japanese population? J Bone Joint Surg Br 93:251–256. doi:10.1302/0301-620X.93B2.25795CrossRefGoogle Scholar
9.
Yassin M, Mitchell C, Diab M, Senior C (2014) The necessity of pharmacological prophylaxis against venous thromboembolism in major joint arthroplasty. Int Orthop 38:1073–1075. doi:10.1007/s00264-013-2233-6CrossRefGoogle Scholar
10.
Jorgensen CC, Jacobsen MK, Soeballe K, Hansen TB, Husted H, Kjaersgaard-Andersen P, Hansen LT, Laursen MB, Kehlet H (2013) Thromboprophylaxis only during hospitalisation in fast-track hip and knee arthroplasty, a prospective cohort study. BMJ Open 3:e003965. doi:10.1136/bmjopen-2013-003965CrossRefGoogle Scholar
11.
Husted H, Otte KS, Kristensen BB, Orsnes T, Wong C, Kehlet H (2010) Low risk of thromboembolic complications after fast-track hip and knee arthroplasty. Acta Orthop 81:599–605. doi:10.3109/17453674.2010.525196CrossRefGoogle Scholar
12.
Kehlet H, Thienpont E (2013) Fast-track knee arthroplasty—status and future challenges. Knee 20(Suppl 1):S29–S33. doi:10.1016/S0968-0160(13)70006-1CrossRefGoogle Scholar
13.
Hu S, Zhang ZY, Hua YQ, Li J, Cai ZD (2009) A comparison of regional and general anaesthesia for total replacement of the hip or knee: a meta-analysis. J Bone Joint Surg Br 91:935–942. doi:10.1302/0301-620X.91B7.21538CrossRefGoogle Scholar
14.
Gomez-Outes A, Terleira-Fernandez AI, Suarez-Gea ML, Vargas-Castrillon E (2012) Dabigatran, rivaroxaban, or apixaban versus enoxaparin for thromboprophylaxis after total hip or knee replacement: systematic review, meta-analysis, and indirect treatment comparisons. BMJ 344:e3675. doi:10.1136/bmj.e3675CrossRefGoogle Scholar
15.
Hunt LP, Ben-Shlomo Y, Clark EM, Dieppe P, Judge A, MacGregor AJ, Tobias JH, Vernon K, Blom AW, National Joint Registry for E, Wales (2014) 45-Day mortality after 467,779 knee replacements for osteoarthritis from the National Joint Registry for England and Wales: an observational study. Lancet 384:1429–1436. doi:10.1016/S0140-6736(14)60540-7CrossRefGoogle Scholar
16.
Hunt LP, Ben-Shlomo Y, Clark EM, Dieppe P, Judge A, MacGregor AJ, Tobias JH, Vernon K, Blom AW, National Joint Registry for England W, Northern I (2013) 90-Day mortality after 409,096 total hip replacements for osteoarthritis, from the National Joint Registry for England and Wales: a retrospective analysis. Lancet 382:1097–1104. doi:10.1016/S0140-6736(13)61749-3

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General, Rodilla

Venous thromboembolism after lower limb arthroplasty: is chemical prophylaxis still needed?

Venous thromboembolism after lower limb arthroplasty: is chemical prophylaxis still needed

Abstract

Background

Purpose

Methods

Results

Conclusions

Keywords

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TRAUMATOLOGÍA DEPORTIVA

ARTÍCULOS MÉDICOS

General, Rodilla

Venous thromboembolism after lower limb arthroplasty: is chemical prophylaxis still needed?

Venous thromboembolism after lower limb arthroplasty: is chemical prophylaxis still needed

Abstract

Background

Purpose

Methods

Results

Conclusions

Keywords

Artículos por Especialidades

NOSOTROS

DOCENCIA

BIBLIOTECA

OTROS

SECRETARÍA TÉCNICA

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