Portable Compression Device and Low-Molecular-Weight Heparin Compared With Low-Molecular-Weight Heparin for Thromboprophylaxis After Total Joint Arthroplasty

Edwards, John Z; Pulido, Pamela A.; Ezzet, Kace A.; Copp, Steven N.; Walker, Richard; Colwell, Clifford W.

doi:10.1016/j.arth.2007.11.006

Cited by 52 publications

(31 citation statements)

References 18 publications

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“…115 Four trials were included [116][117][118][119] ; we identifi ed another study that was published more recently. 120 We reanalyzed the original data by adding this additional study without reextracting the data in the Cochrane review, bringing the total number of patients included to . 2,400.…”

Section: Use Of Combination Thromboprophylaxismentioning

confidence: 99%

Prevention of VTE in Orthopedic Surgery Patients

Falck‐Ytter

Francis²,

Johanson³

et al. 2012

Chest

Self Cite

1,734

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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Section: Use Of Combination Thromboprophylaxismentioning

confidence: 99%

Prevention of VTE in Orthopedic Surgery Patients

Falck‐Ytter

Francis²,

Johanson³

et al. 2012

Chest

Self Cite

1,734

963

View full text Add to dashboard Cite

show abstract

“…With this in mind, early mobilization and pneumatic compression devices have been used with greater frequency following total joint arthroplasty [19,20]. Portable, intermittent pneumatic compression devices have been shown to increase the velocity of venous blood flow in the lower extremities and increase local and systemic fibrinolysis, with reports from multiple institutions showing their effectiveness in VTE prevention [19][20][21][22][23][24][25][26][27]. At our institution, a risk stratification protocol has been implemented in patients undergoing hip arthroplasty in which patients deemed "routine" risk receive a mobile pneumatic compression device in conjunction with aspirin, while patients deemed "high" risk are placed on warfarin for thromboprophylaxis.…”

mentioning

confidence: 99%

Thromboembolism Prophylaxis in Hip Arthroplasty: Routine and High Risk Patients

Nam

Nunley

Johnson

et al. 2015

The Journal of Arthroplasty

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“…Previous guidelines from both organizations (2009 and 2008) viewed outpatient chemoprophylaxis as the standard-of-care and inpatient mechanical compression as adjunctive [16,64,65]. However, with mobile compression device development and concerns about bleeding, compression device usage has become more common among practitioners [16,29,37,66,67].…”

Section: Guidelines: Aaos Accp and Scip Guidelines Relevance To Mecmentioning

confidence: 98%