Multimodal Stratified Approach for Prevention of Thromboembolism in Patients Undergoing Total Hip Arthroplasty

Abstract

Objective: To demonstrate the efficacy and safety of a multimodal stratified approach for prevention of thromboembolism in patients undergoing primary total hip arthroplasty. Method: A longitudinal retrospective clinical study of a cohort of 341 individuals undergoing total hip arthroplasty between March 2008 and July 2016. Of these, 242 patients met the criteria for inclusion in the study. Individuals with a history of deep vein thrombosis or pulmonary thromboembolism, thrombophilia, hypercoagulation conditions, and chronic users of anticoagulants before surgery received enoxaparin at a dose of 40 mg/day for 21 days. For the other group, acetylsalicylic acid was prescribed at a dose of 200 mg/day for 30 days. All patients had surgical risk assessed by the American Anesthesiology Association classified as I or II, and underwent regional anesthesia, effective hydration, the same protocol of early postoperative rehabilitation, and the use of compression stockings. Drug cost analysis was performed based on the Brasíndice. To date, there are no publications in PubMed and Scielo on this subject regarding the Brazilian population. Results: The need for blood transfusion in the enoxaparin group was higher and the overall complication and hemorrhagic rates were also significantly higher (p < 0.010) in this group. Aspirin prescription costs 39 times less than enoxaparin. Conclusion: In patients without predisposing factors to thromboembolism and undergoing primary total hip arthroplasty, the multimodal approach with acetylsalicylic acid seems to be effective, with low cost and a low rate of complications.

Preliminary Report on Phenom&lt;sup&gt;&amp;reg;&lt;/sup&gt; Femoral Component in Total Hip Replacement: The Correlation between Outcome Scores in a Cross-Seccional Study

“…in the immediate preoperative period and 1 gr. every 8 h for 24 h. For thromboembolism prophylaxis, the stratified multimodal approach was adopted [12], with the use of compression stockings, early mobilization, and aspirin (200 mg/day for 30 days) (75.5%), reserving enoxaparin (20 IU/day for 21 days) for cases with high risk for thromboembolism (24.5%). Partial loading with crutches was allowed until the 45th day and afterwards full loading.…”