Mobile Compression Reduces Bleeding-related Readmissions and Wound Complications After THA and TKA

Arsoy, Diren; Giori, Nicholas J.; Woolson, Steven T.

doi:10.1007/s11999.0000000000000041

Cited by 15 publications

(31 citation statements)

References 23 publications

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“…A prospective clinical study of 632 primary TJA patients evaluated the best combination between mechanical treatment (compression) and pharmacological chemoprophylaxis (aspirin and/or low molecular weight heparin) to prevent postoperative thromboembolic events (Table 5) [193].…”

Section: Resultsmentioning

confidence: 99%

Blood management in fast-track orthopedic surgery: an evidence-based narrative review

et al. 2019

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Background and purpose: Innovations able to maintain patient safety while reducing the amount of transfusion add value to orthopedic procedures. Opportunities for improvement arise especially in elective procedures, as long as room for planning is available. Although many strategies have been proposed, there is no consensus about the most successful combination. The purpose of this investigation is to identify information to support blood management strategies in fast-track total joint arthroplasty (TJA) pathway, to (i) support clinical decision making according to current evidence and best practices, and (ii) identify critical issues which need further research. Methods and materials: We identified conventional blood management strategies in elective orthopedic procedures. We performed an electronic search about blood management strategies in fast-track TJA. We designed tables to match every step of the former with the latter. We submitted the findings to clinicians who operate using fast-track surgery protocols in TJA at our research hospital. Results: Preoperative anemia detection and treatment, blood anticoagulants/aggregants consumption, transfusion trigger, anesthetic technique, local infiltration analgesia, drainage clamping and removals, and postoperative multimodal thromboprophylaxis are the factors which can add best value to a fast-track pathway, since they provide significant room for planning and prediction. Conclusion: The difference between conventional and fast-track pathways does not lie in the contents of blood management, which are related to surgeons/surgeries, materials used and patients, but in the way these contents are integrated into each other, since elective orthopedic procedures offer significant room for planning. Further studies are needed to identify optimal regimens.

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Section: Resultsmentioning

confidence: 99%

Blood management in fast-track orthopedic surgery: an evidence-based narrative review

et al. 2019

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“…Chemoprophylaxis and pneumatic compression devices were both given "grade 1" recommendations, which denotes there was certainty that the benefits of these treatments outweighed the potential risks [24]. No subsequent guidelines have been published, but there is a fair amount of research that can aid in supporting the use of ambulatory compression pumps [25][26][27].…”

Section: Discussionmentioning

confidence: 99%

“…The higher risk of bleeding events with stronger chemoprophylaxis has led many surgeons and researchers toward the use of ASA -based VTE prophylaxis regimens [6,12,13,25]. Parvizi et al reported a 0.1% to 0.3% incidence of VTE in a low-risk VTE population undergoing lower extremity arthroplasty with ASA chemoprophylaxis [6].…”

Section: Discussionmentioning

confidence: 99%

“…The use of mobile compression devices alone or with ASA after lower extremity arthroplasty has shown similar VTE rates to more potent chemoprophylaxis in standard-risk patients [25][26][27]. In a multicenter analysis, Colwell et al reported a VTE incidence of 0.92% in 3060 low-risk patients who used ambulatory compression pumps alone after hip and knee arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

“…Colwell et al previously performed a randomized study of ambulatory pumps compared with heparin and found that pumps had equivalent incidence of DVT and VTE as well as significantly less bleeding events [27]. Similarly, Arsoy et al reported no difference in the VTE rates between mobile compression devices with ASA compared with low-molecular-weight heparin with significantly less bleeding events and related complications with the compression device group [25].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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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.

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Personalized delayed anticoagulation therapy alleviates postoperative bleeding in total knee arthroplasty (TKA) patients

Luo,

Wang,

et al. 2024

J. exp. orthop.

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PurposeEcchymosis is one of the most common complications following total knee arthroplasty (TKA), which is closely related to postoperative bleeding. However, it is still controversial whether anticoagulation treatment should be continued for postoperative ecchymosis patients. We suppose that personalized delayed anticoagulation therapy could be beneficial for decreasing postoperative bleeding.MethodsA total of 201 TKA patients were retrospectively included in this study, among whom ecchymosis patients received drug anticoagulation treatment 1–2 days later than usual, while nonecchymosis patients received regular drug anticoagulation treatment. The perioperative blood loss, coagulation state, fibrinolytic state and complications were collected and analyzed.ResultsEighty‐nine patients (44.3%) developed ecchymosis within 3 days after TKA. There were no differences in baseline characteristics between the two groups. In the ecchymosis group, higher K values and lower calculated coagulation index values were observed in thromboelastography, along with greater total blood loss and a more significant decrease in haemoglobin levels on postoperative Day 1 (POD1) compared to the nonecchymosis group. Additionally, the ecchymosis patients exhibited higher levels of fibrinogen degradation products and D‐dimer (D‐D) on POD1, with no differences noted on POD3, indicating that patients with ecchymosis are in a relatively hypocoagulable and hyperfibrinolytic state compared to those without ecchymosis. Therefore, the delayed anticoagulation treatment proved beneficial for correcting these postoperative conditions. No statistically significant differences were found between the two groups in postoperative complications, demonstrating that delayed anticoagulation treatment is safe.ConclusionPatients with ecchymosis exhibited a relatively hypocoagulable and hyperfibrinolytic state with a stronger tendency for postoperative bleeding. Delayed anticoagulation in ecchymosis patients could effectively prevent further exacerbation of postoperative bleeding by avoiding sustained hypocoagulable and hyperfibrinolysis states. Personalized delayed anticoagulation therapy could be beneficial for managing postoperative ecchymosis for TKA patients.Level of EvidenceLevel IV.

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Mobile Compression Reduces Bleeding-related Readmissions and Wound Complications After THA and TKA

Abstract: Level III, therapeutic study.

Cited by 15 publications

References 23 publications

Blood management in fast-track orthopedic surgery: an evidence-based narrative review

Blood management in fast-track orthopedic surgery: an evidence-based narrative review

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

Personalized delayed anticoagulation therapy alleviates postoperative bleeding in total knee arthroplasty (TKA) patients

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