Mechanical prophylaxis, early mobilisation and risk stratification: as effective as drugs for low risk patients undergoing primary joint replacement. Results in 13,384 patients

Gill, Sukhdeep K.; Pearce, Andrea R.; Everington, Tamara; Rossiter, Nigel D.

doi:10.1016/j.surge.2019.11.002

Cited by 9 publications

(13 citation statements)

References 21 publications

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“…These results differ markedly from those coming from other parts of the world. European studies have shown VTE, DVT, and PE rates of 0.79 to1.3%, 0.35 to 0.46%, and 0.35 to 0.57% for THA and 1.5%, 0.3 to 0.51%, and 0.51 to 1.47% for TKA, respectively 70,71,79,92,93 . Januel et al, performed a comparative study between patients who underwent THA in Canada, Switzerland, New Zealand, California, and France 94 .…”

Section: - Is There a Difference In Vte Risk Profile For Patients Und...mentioning

confidence: 99%

“…Pedersen et al, found a median time to VTE that was 20 to 22 days for patients undergoing THA, and 15 days for those who underwent TKA, using Danish registers 64,70 . Gill et al, found a median time for DVT of 16 days in THA and 14 days in TKA in a cohort of more than 13,000 patients in the United Kingdom 71 . Using United States data, several studies have confirmed these findings 68,72-74 .…”

Section: - Is There a Difference In Vte Risk Profile For Patients Und...mentioning

confidence: 99%

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Recommendations from the ICM-VTE: Hip & Knee

2022

Journal of Bone and Joint Surgery

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The ICM-VTE Hip & Knee Delegates* 1 -Is VTE after elective total joint arthroplasty a "never event"?Response/Recommendation: Venous thromboembolism (VTE) after elective total joint arthroplasty (TJA) continues to occur despite various strategies in prophylaxis and should not be considered a "never event."Strength of Recommendation: Moderate.Delegates vote: Agree 94.87% Disagree 5.13% Abstain 0.00% (Strong Consensus).Rationale: As part of an initiative to address quality of care and control healthcare costs, in 2002, the United States Centers for Medicare and Medicaid Services (CMS) defined "never events" as hospital-acquired conditions that were considered reasonably preventable 1 . In 2008, CMS added deep venous thrombosis (DVT) and pulmonary embolism (PE) following total knee arthroplasty (TKA) and total hip arthroplasty (THA) 2 .Historically, DVT and PE were important risks for patients undergoing TJA. In a study of 7,959 patients between 1962 and 1973, Charnley et al., reported a non-fatal PE rate of 7.89% and a 1.04% rate of fatal PE which constituted the highest single cause of death after a THA 3 . Coventry et al., identified a cohort of 2012 THA from 1969 to 1971 of which 58 did not receive chemoprophylaxis past post-operative day five and observed a DVT rate of 3.4%, a non-fatal PE rate of 5.2%, and a fatal PE rate of 3.4% 4,5 . In a series performed between 1990 and 1991, Warwick et al., identified 1,162 patients undergoing THA without routine chemoprophylaxis, with DVT confirmed by venography in 1.89% of patients and a PE rate of 1.20% with a subsequent mortality rate of 0.34% 6 .Early studies demonstrated a much higher incidence of VTE for TKA 7,8 . However, DVT in TKA patients occur distally in the calf which are less likely to progress into a PE which was observed at a rate of 1.3% 9 with fatalities of 0.19 to 0.4% 9,10 . Stulburg et al., examined a series of 638 patients from 1974 to 1979 among which 49 patients inadvertently did not receive prophylaxis; an impressive 83% of these patients developed a DVT 11 .In a prospective study with 34,397 consecutive and unselected THA or TKA procedures, 32 (0.09%) had a VTE after median two days despite ongoing thromboprophylaxis 12 . All surgery was done in a fast-track setup with accelerated mobilization and discharge. Another study has shown a 90-day incidence of 0.41% of VTE after unicompartmental knee arthroplasty 13 . All patients received thromboprophylaxis until discharge and were operated in a fast-track setup with a median length of stay of one day.With VTE as a common and potentially dangerous complication after TKA and THA, safe and effective strategies for prophylaxis were developed and studied. When warfarin dosage is titrated to an international normalized ratio (INR) of 1.5 to 2.0 and administered for approximately six weeks, DVT occurred at a rate of 0.2 to 1% with a non-fatal PE rate of 0.1 to 0.3% [14][15][16] . Warfarin was found to consistently decreased rates of VTE when utilized after THA or TKA, but may lead to a significant risk ...

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Section: - Is There a Difference In Vte Risk Profile For Patients Und...mentioning

confidence: 99%

Section: - Is There a Difference In Vte Risk Profile For Patients Und...mentioning

confidence: 99%

Recommendations from the ICM-VTE: Hip & Knee

2022

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

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“…A current retrospective study on 13,384 TKA and THA patients, who did not have increased VTE risk and had mechanical VTE prophylaxis together with early mobilization, showed that they had comparable VTE rates to those of patients who had pharmacological VTE prophylaxis [ 7 ].…”

Section: Statements Of Group 2: Mechanical Venous Thromboembolism Prophylaxismentioning

confidence: 99%

“…However, there was no statistical significance [ 15 ]. Although a retrospective study in Korean patients with no elevated VTE risk who were undergoing TKA reported that the use of IPCD alone did not reduce the DVT incidence [ 6 ], the recent retrospective study on 13,384 patients undergoing TKA and THA reported that mechanical prophylaxis with early mobilization provides comparable VTE rates to those for patients who had pharmacological VTE prophylaxis [ 7 ].…”

Section: Statements Of Group 2: Mechanical Venous Thromboembolism Prophylaxismentioning

confidence: 99%

“…There were no reported fatal PEs [ 14 ]. The incidence of symptomatic DVT was significantly lower compared to that of the historical control group [ 7 ]. Although some studies provided a lower incidence of VTE in Asian patients undergoing total joint arthroplasty compared to their Western counterparts, VTE prevention results were similar between patients who had mechanical prophylaxis alone and patients who had combined mechanical and pharmacological prophylaxis [ 16 , 17 ].…”

Section: Statements Of Group 2: Mechanical Venous Thromboembolism Prophylaxismentioning

confidence: 99%

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Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: Part 2. Mechanical venous thromboembolism prophylaxis

Thiengwittayaporn

Budhiparama

Tanavalee

et al. 2021

Knee Surg & Relat Res

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Assessment of risk-stratified approach to thromboprophylaxis in hip arthroplasty patients: a prospective cohort study

Bhaskarwar¹,

Kumar²

2022

Current Orthopaedic Practice

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Background:Venous thromboembolism (VTE) is a frequent and serious complication in orthopaedic surgeries of the lower limbs. Subsequent pulmonary embolism (PE) makes it the most common cause of death after joint replacement surgeries of the lower limbs. In this study, a multimodal approach for thromboprophylaxis was adopted in patients undergoing total hip replacement (THR) and hemiarthroplasty (HA), including pharmaceutical and mechanical agents recommended by the American Academy of Orthopaedic Surgeons (AAOS) as per risk stratified approach, and the effectiveness of the same was measured by clinical and radiographic assessment. Methods:This was a prospective observational longitudinal study with evaluation at multiple points of time carried out at a tertiary care orthopaedic center. The study included 66 consecutive patients who underwent hip replacement arthroplasty (45 THR, 21 HA). Mechanical and pharmacological (soluble aspirin) prophylaxis modalities for deep venous thrombosis (DVT) were administered to all patients after risk stratification. Patients were assessed for evidence of DVT at 2,6, and 12 wk postoperatively by clinical tests and color Doppler flow imaging (CDFI). Results:This study confirmed efficacy of AAOS recommended risk stratified approach of thromboprophylaxis by combined use of soluble aspirin and various other mechanical measures in patients having standard risk for PE and bleeding undergoing THR or HA because none of the patients developed DVT per clinical assessment and confirmed by CDFI carried out at follow-up. Conclusions:Prevention of DVT as recommended by AAOS has proven to be effective as well as cheaper in moderate-risk patients undergoing hip replacement surgery. Though there were no major differences in complication rates in respect to other prophylaxis except prevalence of major bleeding was very low.

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Mechanical prophylaxis, early mobilisation and risk stratification: as effective as drugs for low risk patients undergoing primary joint replacement. Results in 13,384 patients

Cited by 9 publications

References 21 publications

Recommendations from the ICM-VTE: Hip & Knee

Recommendations from the ICM-VTE: Hip & Knee

Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: Part 2. Mechanical venous thromboembolism prophylaxis

Assessment of risk-stratified approach to thromboprophylaxis in hip arthroplasty patients: a prospective cohort study

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