Efficacy and Safety of Prolonged Thromboprophylaxis with a Low Molecular Weight Heparin (Dalteparin) after Total Hip Arthroplasty— The Danish Prolonged Prophylaxis (DaPP) Study

Lassen, Michael R.; Borris, Lars C.; Anderson, Berry; Jensen, Hans Peter; Bro, H.P.Skejø; Andersen, Grethe; Petersen, Antje; Siem, P; Hørlyck, Erik; Jensen, B.V; Thomsen, Poul-Erik Bloch; Hansen, Børge Rottbøll; Erin‐Madsen, J.; Møller, Jan; Rotwitt, L; Christensen, Finn Kjær; Nielsen, Jimmi; Jørgensen, Per Schultz; Paaske, B. P.; Tørholm, C; Hvidt, P; Jensen, Nathan K.; Nielsen, Anne Bjerg; Appelquist, E; Hansen, O.G; Mortensen, Deborah L.; Tjalve, E

doi:10.1016/s0049-3848(98)00018-8

Cited by 170 publications

(130 citation statements)

References 16 publications

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“…Studies of patients who underwent THR have indicated that extending anticoagulant prophylaxis with LMWH to 4-5 weeks postoperatively significantly reduces the incidence of venographically-detected DVT, as compared to a regimen of only 1-2 weeks (Bergqvist et al 1996, Planes et al 1996, Dahl et al 1997, Lassen et al 1998, Hull et al 2000, Comp et al 2001. Three recent meta-analyses have shown a relative reduction in venographically-proven subclinical DVT that parallels a similar reduction in postoperative clinical thromboembolic events (Cohen et al 200 1, Eikelboom et al 2001, Hull et al 2001.…”

Section: Discussionmentioning

confidence: 99%

Risk of clinical pulmonary embolism after joint surgery in patients receiving low-molecular-weight heparin prophylaxis in hospital

Dahl¹,

Gudmundsen²,

Bjørnarå³

et al. 2003

Acta Orthopaedica Scandinavica

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Section: Discussionmentioning

confidence: 99%

Risk of clinical pulmonary embolism after joint surgery in patients receiving low-molecular-weight heparin prophylaxis in hospital

Dahl¹,

Gudmundsen²,

Bjørnarå³

et al. 2003

Acta Orthopaedica Scandinavica

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“…2,600 patients mainly after THA [54][55][56][57][58][59][60] ; one trial also included TKA patients. 55 Most trials randomized patients at discharge (which occurred 6-14 days postoperation) to continue with LMWH vs placebo until postoperative days 27 to 35.…”

Section: Baseline Risk For Major Bleeding Eventsmentioning

confidence: 99%

Prevention of VTE in Orthopedic Surgery Patients

Falck‐Ytter

Francis²,

Johanson³

et al. 2012

Chest

1,729

963

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Background: VTE is a serious, but decreasing complication following major orthopedic surgery. This guideline focuses on optimal prophylaxis to reduce postoperative pulmonary embolism and DVT. Methods: The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results: In patients undergoing major orthopedic surgery, we recommend the use of one of the following rather than no antithrombotic prophylaxis: low-molecular-weight heparin; fondaparinux; dabigatran, apixaban, rivaroxaban (total hip arthroplasty or total knee arthroplasty but not hip fracture surgery); low-dose unfractionated heparin; adjusted-dose vitamin K antagonist; aspirin (all Grade 1B); or an intermittent pneumatic compression device (IPCD) (Grade 1C) for a minimum of 10 to 14 days. We suggest the use of low-molecular-weight heparin in preference to the other agents we have recommended as alternatives (Grade 2C/2B), and in patients receiving pharmacologic prophylaxis, we suggest adding an IPCD during the hospital stay (Grade 2C). We suggest extending thromboprophylaxis for up to 35 days (Grade 2B). In patients at increased bleeding risk, we suggest an IPCD or no prophylaxis (Grade 2C). In patients who decline injections, we recommend using apixaban or dabigatran (all Grade 1B). We suggest against using inferior vena cava fi lter placement for primary prevention in patients with contraindications to both pharmacologic and mechanical thromboprophylaxis (Grade 2C). We recommend against Doppler (or duplex) ultrasonography screening before hospital discharge (Grade 1B). For patients with isolated lowerextremity injuries requiring leg immobilization, we suggest no thromboprophylaxis (Grade 2B). For patients undergoing knee arthroscopy without a history of VTE, we suggest no thromboprophylaxis (Grade 2B). Conclusions: Optimal strategies for thromboprophylaxis after major orthopedic surgery include pharmacologic and mechanical approaches. CHEST 2012; 141(2)(Suppl):e278S-e325SAbbreviations: DUS 5 Doppler (or duplex) ultrasonography; GCS 5 graduated compression stockings; HFS 5 hip fracture surgery; INR 5 international normalized ratio; IPCD 5 intermittent pneumatic compression device; IVC 5 inferior vena cava; LDUH 5 low-dose unfractionated heparin; LMWH 5 low-molecular-weight heparin; PE 5 pulmonary embolism; PEP 5 Pulmonary Embolism Prevention trial; RCT 5 randomized controlled trial; RR 5 risk ratio; THA 5 total hip arthroplasty; TKA 5 total knee arthroplasty; UFH 5 unfractionated heparin; VFP 5 venous foot pump; VKA 5 vitamin K antagonist

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“…Currently, the mean length of hospital stay is between 3 to 4 days, therefore full compliance with this recommendation is difficult for both the patient and the provider. Several studies have reported that continuation of thromboprophylaxis beyond the hospitalization is efficacious and safe in the risk reduction of late VTE in surgical patients (Planes et al, 1996;Lassen et al, 1998;Comp et al, 2001;Bergqvist et al, 2002;Rasmussen et al, 2006).…”

Section: Extended Duration Prophylaxismentioning

confidence: 99%