Ambulatory Portable Pneumatic Compression Device as Part of a Multimodal Aspirin-Based Approach in Prevention of Venous Thromboembolism in Outpatient Total Knee Arthroplasty

Abstract

Background: The purpose of this study is to review the incidence of symptomatic venous thromboembolism (VTE) in patients undergoing outpatient primary total knee arthroplasty (TKA) who used a portable pneumatic compression device as part of their VTE prophylaxis protocol. Methods: A retrospective review of all outpatient primary TKA procedures in which patients used ambulatory pneumatic compression pumps as part of their multimodal VTE prophylaxis was performed from 2016 through 2018. This yielded a cohort of 1131 patients (1453 TKAs). An aspirin (ASA)-based protocol was used in patients with standard VTE risk receiving either 81 mg or 325 mg of ASA twice daily for 6 weeks postoperatively. High-risk patients received a stronger chemoprophylaxis for 2 weeks followed by ASA for 4 weeks. Pneumatic compression pumps were worn for 23 hours/day for 14 days. Results: VTE prophylaxis medication was 81-mg ASA in 56% of patients, 325-mg ASA in 10% of patients, and stronger chemoprophylaxis in 34% of patients. Patients were considered morbidly obese (body mass index >40 kg/m 2) in 267 (18.4%) procedures. Ninety-seven (6.7%) patients had a preoperative history of VTE event. Forty-nine duplex ultrasounds were performed (3.3% of TKAs). Confirmed VTE events were documented in only 5 (0.3%) patients. All VTEs occurred in high-risk patients who were discharged on stronger chemoprophylaxis. The time (days) to VTE was 3, 3, 7, 45, and 88 days. Conclusions: The use of portable pneumatic compression pumps as part of a multimodal VTE prophylaxis protocol aided in a very low rate of symptomatic VTE events in patients undergoing outpatient primary TKA.

Low-Dose Aspirin Thromboprophylaxis Is Safe and Effective in Patients Undergoing Total Hip Arthroplasty with or without Outpatient Pneumatic Compression Devices

“…10, 12,31,32 Previous studies have shown that the combined use of mobile IPCDs and ASA is effective in reducing VTE incidence in patients undergoing TKA. 21,22 Crawford et al reviewed VTE rates in a retrospective cohort of 1,131 TKA patients at standard and high risk for VTE on a combined protocol of mobile IPCDs with either 81-mg ASA BID, 325-mg ASA BID, or stronger chemoprophylactic agents. 22 They found that their study's VTE events were in high-risk patients using non-ASA therapy and concluded that the combined protocol was effective for VTE prophylaxis.…”

“…21,22 Crawford et al reviewed VTE rates in a retrospective cohort of 1,131 TKA patients at standard and high risk for VTE on a combined protocol of mobile IPCDs with either 81-mg ASA BID, 325-mg ASA BID, or stronger chemoprophylactic agents. 22 They found that their study's VTE events were in high-risk patients using non-ASA therapy and concluded that the combined protocol was effective for VTE prophylaxis. However, the authors did not attempt to compare or comment on the efficacy of VTE prevention in patients using a protocol without mobile IPCDs.…”

“…21 In addition to mechanical prophylaxis, the use of pharmacologic agents, such as ASA for chemoprophylaxis, has been well studied and supported. 20,22,27,29 ASA has been shown to be cost-effective and as safe and effective in preventing VTE and minimizing postoperative bleeding, wound complications, infection, and mortality in THA as other anticoagulation agents such as warfarin, LMWH, or direct factor Xa inhibitors. 10,11,17,18,30 Multimodal protocols utilizing 81-mg ASA BID may be favored over protocols using 325-mg ASA BID due to the better safety profile and similar efficacy in VTE prevention with low-dose ASA following THA.…”

“…19,20 Other studies have also shown that extended use of portable IPCDs with ASA chemoprophylaxis may further decrease VTE incidence compared with inpatient IPCD use alone. 21,22 However, portable IPCD use may be associated with poor compliance, skin tears, falls, decreased patient satisfaction, and may be cost prohibitive for patients who cannot afford to pay for them either out-of-pocket or from insurance companies that may not be willing to pay. [23][24][25][26] Several studies have demonstrated the efficacy of multimodal approaches to VTE prophylaxis that include outpatient use of mobile IPCDs and ASA chemoprophylaxis.…”

“…[23][24][25][26] Several studies have demonstrated the efficacy of multimodal approaches to VTE prophylaxis that include outpatient use of mobile IPCDs and ASA chemoprophylaxis. [20][21][22]27 Other studies have shown the efficacy of low-dose (81 mg) ASA alone for VTE prophylaxis. [10][11][12][13][14][15]18 However, few studies have investigated if a regimen including outpatient use of mobile IPCDs with ASA provides more effective prophylaxis than ASA alone.…”