High and low-dose aspirin prophylaxis against venous thromboembolic disease in total hip replacement.

The efficacy and safety of aspirin prophylaxis in preventing deep vein thrombosis is now scientifically established. This was done in a prospective, randomized, simultaneously controlled, double-blind, placebo study using objective diagnostic methods in 98 patients over age 40 undergoing total hip replacement surgery. All patients had fibrinogen uptake tests, cuff impedance phlebography, and radiographic phlebography. The one patient with postoperative pulmonary signs or symptoms had Q/V pulmonary scans and selective pulmonary angiography. Twenty-three of fifty-one patients in the control group developed thromboembolic disease, compared to eleven of forty-seven in the aspirin group (P < 0.02, Fisher Exact Test). The embolus occurred in the control group. There were no deaths. Aspirin was given as 1.2 grams daily starting preoperatively.To study the efficacy of this prophylaxis without the use of early surveillance diagnostic methods, four hundred ninety-eight consecutive patients over 40 years of age undergoing total hip replacement had aspirin prophylaxis but only clinical diagnosis was used. No fatal pulmonary emboli occurred. The only fatality was shown at postmortum not to be caused by an embolus. All patients with pulmonary signs or symptoms had perfusion pulmonary scans. Only seven patients had objectively demonstrated, nonfatal, pulmonary emboli (1.4%).

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Prevention of Readmission for Venous Thromboembolic Disease after Total Hip Arthroplasty

Yearbook of Orthopedics ◽

10.1016/s0276-1092(08)70119-6 ◽

2007 ◽

Vol 2007 ◽

pp. 116-118

Author(s):

B.F. Morrey

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Thromboembolic Disease ◽

Venous Thromboembolic Disease ◽

Total Hip ◽

Venous Thromboembolic

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The Hemodynamic and Fibrinolytic Response to Low Dose Epinephrine and Phenylephrine Infusions During Total Hip Replacement Under Epidural Anesthesia

Thrombosis and Haemostasis ◽

10.1055/s-0038-1646293 ◽

1992 ◽

Vol 68 (04) ◽

pp. 436-441 ◽

Cited By ~ 23

Author(s):

Nigel E Sharrock ◽

George Go ◽

Robert Mineo ◽

Peter C Harpel

Keyword(s):

Heart Rate ◽

Deep Vein Thrombosis ◽

Cardiac Index ◽

Total Hip Replacement ◽

Epidural Anesthesia ◽

Hip Replacement ◽

Low Dose ◽

Total Hip ◽

Vein Thrombosis ◽

Deep Vein

SummaryLower rates of deep vein thrombosis have been noted following total hip replacement under epidural anesthesia in patients receiving exogenous epinephrine throughout surgery. To determine whether this is due to enhanced fibrinolysis or to circulatory effects of epinephrine, 30 patients scheduled for primary total hip replacement under epidural anesthesia were randomly assigned to receive intravenous infusions of either low dose epinephrine or phenylephrine intraoperatively. All patients received lumbar epidural anesthesia with induced hypotension and were monitored with radial artery and pulmonary artery catheters.Patients receiving low dose epinephrine infusion had maintenance of heart rate and cardiac index whereas both heart rate and cardiac index declined significantly throughout surgery in patients receiving phenylephrine (p = 0.0001 and p = 0.0001, respectively). Tissue plasminogen activator (t-PA) activity increased significantly during surgery (p <0.0005) and declined below baseline postoperatively (p <0.005) in both groups. Low dose epinephrine was not associated with any additional augmentation of fibrinolytic activity perioperatively. There were no significant differences in changes in D-Dimer, t-PA antigen, α2-plasmin inhibitor-plasmin complexes or thrombin-antithrombin III complexes perioperatively between groups receiving low dose epinephrine or phenylephrine. The reduction in deep vein thrombosis rate with low dose epinephrine is more likely mediated by a circulatory mechanism than by augmentation of fibrinolysis.

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Low-Dose Heparin and Deep-Vein Thrombosis after Total Hip Replacement

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648020 ◽

1976 ◽

Vol 36 (01) ◽

pp. 157-164 ◽

Cited By ~ 34

Author(s):

P. M Mannucci ◽

Luisa E. Citterio ◽

N Panajotopoulos

Keyword(s):

Deep Vein Thrombosis ◽

Total Hip Replacement ◽

Hip Replacement ◽

Low Dose ◽

Control Group ◽

Total Hip ◽

Vein Thrombosis ◽

Dose Heparin ◽

Deep Vein ◽

Low Dose Heparin

SummaryThe effect of subcutaneous low-dose heparin on postoperative deep-vein thrombosis (D. V. T.) (diagnosed by the 125I-labelled fibrinogen test) has been investigated in a trial of 143 patients undergoing the operation of total hip replacement. Two randomized studies were carried out: in one the scanning for D.V.T. was carried out daily for 7 days post operatively and in the other for 15 days. In both, the incidence of D.V.T. was significantly lower in the heparin-treated patients (P<0.005). Bilateral D.V.T. was also prevented (P<0.05), through the extension of D.V.T. to the distal veins of the thigh was not significantly reduced. Heparin treatment was, however, followed by a higher incidence of severe postoperative bleeding (P< 0.02) and wound haematoma formation (P< 0.005), and the postoperative haemoglobin was significantly lower than in the control group (P<0.005). A higher number of transfused blood units was also needed by the heparin treated patients (P<0.001).

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