Prophylaxis for Venous Thromboembolism in Total Hip Arthroplasty: A Review

ABSTRACT Objectives: To evaluate the effectiveness of aspirin as prophylaxis for deep venous thrombosis (DVT) in patients undergoing total hip arthroplasty (THA), and to analyze the incidence of bleeding during the post-operative period. Methods: This prospective study carried out in 2017 consisted of 37 patients indicated for THA with high risk for DVT. Immediately after the procedure, aspirin, elastic compression socks and early deambulation were initiated. Doppler ultrasound was performed in the legs 6 days and 6 weeks post-procedure to rule out venous thromboembolism. Hematometric variables and clinical criteria were used to detect bleeding. Results: The incidence of VTE (venous thromboembolism) 6 days post-procedure was 21.6%. By 6 weeks post-procedure, it dropped to 8.1%, (p = 0.102). Only 2.7% were diagnosed with VTE, 6 days and also 6 weeks post-procedure. Within the immediate postoperative period, hemoglobin was lower (p < 0.001), in contrast to 6 weeks after surgery, when it returned to baseline levels. Conclusion: Aspirin was an effective chemical prophylaxis for venous thromboembolism in high-risk patients who underwent THA. There was no clinical record of postoperative bleeding and hematometric levels suggested that there was no chronic bleeding. Level of Evidence II; Prospective study.

Download Full-text

Efficacy of Combined Modality Prophylaxis Including Short-Duration Warfarin to Prevent Venous Thromboembolism After Total Hip Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2005.06.017 ◽

2006 ◽

Vol 21 (4) ◽

pp. 469-475 ◽

Cited By ~ 21

Author(s):

James A. Keeney ◽

John C. Clohisy ◽

Madelyn C. Curry ◽

William J. Maloney

Keyword(s):

Venous Thromboembolism ◽

Total Hip Arthroplasty ◽

Short Duration ◽

Hip Arthroplasty ◽

Total Hip ◽

Combined Modality

Download Full-text

Incidence of silent venous thromboembolism after total hip arthroplasty: A comparison of rivaroxaban and enoxaparin

Journal of Orthopaedic Surgery ◽

10.1177/2309499020938865 ◽

2020 ◽

Vol 28 (2) ◽

pp. 230949902093886

Author(s):

Wael A. Rahman ◽

Gamal H Habsa ◽

Omar A. Al-Mohrej ◽

Mohammed Hammad ◽

Naser M. Selim ◽

...

Keyword(s):

Venous Thromboembolism ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Significant Risk ◽

Secondary Outcome ◽

Total Hip ◽

Below The Knee ◽

Laboratory Investigations ◽

A Prospective Study ◽

Body Mass Indexes

Propose: Total hip arthroplasty (THA) is associated with a significant risk of venous thromboembolism (VTE). Different thromboprophylaxis strategies have been used to prevent VTE. The primary aim of this study was to report the incidence of VTE and compare the efficacy and safety of rivaroxaban to enoxaparin. The secondary outcome was to report the incidence of silent deep venous thrombosis (DVT) using computed tomography venography. Methods: One hundred sixty patients who underwent THA were enrolled in a prospective study. Patients were randomized into two groups as follows: those who received rivaroxaban 10 mg oral daily (group RXE) and those who received enoxaparin 40 IU/day subcutaneously for 14 days (group ENO). Results: Both groups were matched for age, sex, comorbidities, special habits and preoperative laboratory investigations. The overall incidence of DVT was 5% ( n = 8), which included four patients clinically diagnosed as having DVT and four with silent DVT. All the DVT cases occurred in veins below the knee and in the group RXE; none of the cases occurred in group ENO ( p = 0.04). The incidence of DVT was significantly higher in patients with high body mass indexes ( p < 0.001), older age ( p = 0.024) and medical comorbidities ( p = 0.14). No mortality, pulmonary embolism, stroke, wound infection or major bleeding occurred in either group. Conclusions: Among the patients who underwent hip arthroplasty, rivaroxaban prophylaxis was found to be associated with lower efficacy and similar safety outcomes as compared with enoxaparin anticoagulants.

Download Full-text