Prevention of Deep-Vein Thrombosis after Total Hip Arthroplasty

Francis, Charles W.; Pellegrini, Vincent D.; Tötterman, S.; Boyd, Allen D.; Marder, Victor J.; Liebert, Kristin M.; Stulberg, Bernard N.; Ayers, David C.; Rosenberg, Aaron S; Kessler, Craig M.; Johanson, Norman A.

doi:10.2106/00004623-199709000-00011

Cited by 160 publications

(117 citation statements)

References 37 publications

Supporting

Mentioning

113

Contrasting

Unclassified

Order By: Relevance

“…Some researchers use a decrease in hemoglobin greater than 2 g/dL in the definition of major bleeding [11], and the rate of major bleeding frequently is reported as a safety outcome in trials of thromboprophylaxis [9,13,16,23]. We found such a decrease in hemoglobin for the majority of patients until the first postoperative injection (83% versus 90%) and the day after surgery (93% versus 90%), which indicates a decrease in hemoglobin is a poor parameter for defining major bleeding in patients undergoing THA.…”

Section: Discussionmentioning

confidence: 99%

“…Type of antithrombotic drug, dosage, and timing of the first dose may influence bleeding and development of thrombosis. Low-molecular-weight heparins (LMWHs) are widely used antithrombotics because of their favorable efficacy-to-safety profiles [9,23], but the best timing of the first dose remains controversial [24,28]. Preoperative initiation 12 hours before surgery has been based on the premise that DVT starts during surgery and that preoperative initiation is necessary to optimize antithrombotic effectiveness [17,27].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Blood Loss in Cemented THA is not Reduced with Postoperative Versus Preoperative Start of Thromboprophylaxis

Borgen

Dahl

Reikerås

2012

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Thrombin formation commences perioperatively in orthopaedic surgery and therefore some surgeons prefer preoperative initiation of pharmacologic thromboprophylaxis. However, because of the potential for increased surgical bleeding, the postoperative initiation of thromboprophylaxis has been advocated to reduce blood loss, need for transfusion, and bleeding complications. Trials on timing of thromboprophylaxis have been designed primarily to detect thrombotic events, and it has been difficult to interpret the magnitude of blood loss and bleeding events owing to lack of information for bleeding volume and underpowered bleeding end points. Questions/purposes We therefore asked whether there are differences in blood loss, transfusion requirements, and other postoperative clinical complications with preoperative versus postoperative start of thromboprophylaxis with dalteparin. Methods In a double-blind, randomized controlled trial, 80 patients undergoing primary cemented THA were allocated to dalteparin injections starting 12 hours before or 6 hours after surgery. Blood loss was measured by weighing sponges and drapes, volume in suction drains during surgery, and wound drains until removal 24 hours postoperatively. Hemoglobin and hematocrit were recorded at predefined times during and after surgery. Results We found no differences in blood loss (1081 mL ± 424 mL versus 1023 mL ± 238 mL), bleeding-related events (10% versus 17%), or number of patients who had transfusions (12 versus five) with preoperative and postoperative thromboprophylaxis, respectively. Other complications were few in both groups. Conclusions Our data suggest blood loss is similar with preoperative and postoperative initiation of dalteparin thromboprophylaxis, but indicate a trend toward fewer transfusion requirements which might favor postoperative start of thromboprophylaxis.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Blood Loss in Cemented THA is not Reduced with Postoperative Versus Preoperative Start of Thromboprophylaxis

Borgen

Dahl

Reikerås

2012

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Bleeding is more common with Group A anticoagulants. Bleeding [5,8,17,18,23,26,41,42,52,55,61] can lead to death from multiple causes, including shock, renal failure, stroke, myocardial infarction, infection, and sepsis. It is likely complications of bleeding contributed to the increased mortality.…”

Section: Discussionmentioning

confidence: 99%

Potent Anticoagulants are Associated with a Higher All-Cause Mortality Rate After Hip and Knee Arthroplasty

Sharrock

Valle

et al. 2008

Clinical Orthopaedics &Amp; Related Research

163

116

View full text Add to dashboard Cite

show abstract

“…Thromboprophylaxis in close proximity to hip arthroplasty, either preoperatively or postoperatively, may balance efficacy and safety to prevent thrombosis on one hand and bleeding on the other hand. Clinical observations indicated that LMWH at half the usual high-risk dose begun in close proximity to THA either preoperatively or postoperatively [39,40] was more effective than LMWH administered 12 hours preoperatively or 12-18 hours postoperatively [17,19]. However, administration less than 2 hours before surgery resulted in increased major bleeding, while a postoperative regimen of LMWH 4-6 hours after surgery provided efficacy without significantly increasing bleeding [40].…”

Section: Discussionmentioning

confidence: 99%

Time course of thrombosis and fibrinolysis during total hip surgery

Reikerås¹,

Clementsen²,

Bjørnsen³

2006

J Orthopaed Traumatol

View full text Add to dashboard Cite

Venous thrombosis is common in elective hip surgery, and prophylactic treatment is used up to 12 hours before or after surgery. Recent clinical trials suggested that the timing of initiating prophylaxis significantly influenced the antithrombotic effectiveness. Furthermore, the timing of initiating antifibrinolytic treatment to reduce blood loss has been a question of debate. We studied the time course of coagulation and fibrinolysis at all phases during total hip arthroplasty. Specific markers of thrombosis (prothrombin fragment F1.2) and of fibrinolysis (plasminantiplasmin (PAP) and D-dimer) were examined in eight female and two male patients aged 16–62 years. There was a progressive increase in plasma concentrations of F1.2 during the operation. From the end of operation to 4 hours afterwards, there was no further increase in F1.2. Levels of D-dimer did not change until wound closure, when they began to increase up to 4 hours postoperatively, but there were no changes in PAP during the operation or during the 4-h postoperative period. Therefore, surgery for total hip arthroplasty activates thrombin generation during operation with fibrin degradation at a later stage. These observations harmonize with the notion that the interval between surgery and first administration of antithrombotic treatment is a critical variable.

show abstract

Prevention of Deep-Vein Thrombosis after Total Hip Arthroplasty

Cited by 160 publications

References 37 publications

Blood Loss in Cemented THA is not Reduced with Postoperative Versus Preoperative Start of Thromboprophylaxis

Blood Loss in Cemented THA is not Reduced with Postoperative Versus Preoperative Start of Thromboprophylaxis

Potent Anticoagulants are Associated with a Higher All-Cause Mortality Rate After Hip and Knee Arthroplasty

Time course of thrombosis and fibrinolysis during total hip surgery

Contact Info

Product

Resources

About