Thrombo-embolic prophylaxis in total knee replacement. Evaluation of the A-V Impulse System

Wilson, NV; Sk, Das; Vv, Kakkar; Hd, Maurice; Smibert, JG; Thomas, EM; Nixon, John

doi:10.1302/0301-620x.74b1.1732265

Cited by 118 publications

(66 citation statements)

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“…900 patients undergoing arthroplasty or HFS compared mechanical compression to no thromboprophylaxis. 31,66,[76][77][78][79] Six used an IPCD, and one a venous foot pump (VFP). 77 The risk of bias varied.…”

Section: Mechanical Interventions Vs No Prophylaxisinitial Prophylaxismentioning

confidence: 99%

Prevention of VTE in Orthopedic Surgery Patients

Falck‐Ytter

Francis²,

Johanson³

et al. 2012

Chest

1,738

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: Mechanical Interventions Vs No Prophylaxisinitial Prophylaxismentioning

confidence: 99%

Prevention of VTE in Orthopedic Surgery Patients

Falck‐Ytter

Francis²,

Johanson³

et al. 2012

Chest

1,738

963

View full text Add to dashboard Cite

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“…[1][2][3][4][5][6][7] Most of these series were of cemented prostheses; it is possible therefore that cement may have thrombogenic properties and so influence the incidence of DVT. Reports concerning this are conflicting; activation of the clotting cascade and concurrent fibrinolysis have been described during and after TKR and THR, 8,9 but it is uncertain whether this activation is different in cemented compared with uncemented prostheses.…”

mentioning

confidence: 99%

Cement as a risk factor for deep-vein thrombosis

Clarke

Green

Harper

et al. 1998

The Journal of Bone and Joint Surgery. British volume

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A total of 110 total knee replacements (TKRs) was randomised to receive either a cemented or an uncemented prosthesis. Postoperative venography at five to seven days was used to compare the prevalence, site and size of deep-vein thrombosis (DVT). We also compared the findings with those of postoperative venography in a group of patients with cemented total hip replacements (THRs).The total prevalence of DVT was significantly greater after uncemented (81%) than after cemented TKR (55%). Both knee groups had a significantly higher prevalence of DVT than in cemented hip replacements (32%). We found no difference in the proportion with proximal DVT in the three groups (14%, 15% and 16%). The median length of the thrombi was significantly greater after cemented (26.5 cm) than after uncemented TKR (11 cm) or after cemented THR (7 cm). This difference was mainly due to greater lengths of distal rather than proximal thrombi.We conclude that the use of cement may affect the formation of DVT after joint replacement, but does not appear to lead to an increased incidence.

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“…In one trial including 290 hip surgery patients and comparing the method with 40 mg enoxaparin, there was no statistically significant difference in the rate of venographic DVT. 22 In TKR surgery, it has been shown to be efficacious in preventing venographic DVT in two small studies, 23,24 but LMWH was more so in two other trials. 25,26 In a more recent study, neither method provided superior prophylaxis.…”

Section: Plantar Compression Using Foot Pumpsmentioning

confidence: 99%

Prevention of postoperative venous thromboembolism. Risk assessment and methods of prophylaxis

Motte

Samama

Guay

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: To describe risk assessment models that have been developed to stratify patients into different risk levels of postoperative venous thromboembolism (VTE) and then to review the different methods of prophylaxis and to outline the evidence supporting their effectiveness and safety.Source: Our review of the literature is focused on consensus documents, recent large randomized trials and meta-analyses. Principal findings:The risk of VTE is determined by the type of surgery and underlying patient factors. Risk assessment models are useful in stratifying patients into different VTE risk levels. However, multiple risk factors are often present in the same patient and in practice the evaluation of their relative contribution to the overall risk remains difficult. A variety of prophylactic strategies including physical and pharmacological methods have been shown to be effective in different patient groups. Patients with a moderate or high risk of VTE should receive prophylaxis consisting of an antithrombotic agent, unless contraindicated, used alone or in combination with a mechanical method. Recommendations concerning which prophylaxis to use and how intensive it should be are based mainly on data from trials using surrogate endpoints, and do not translate easily into practical decisions aiming to reduce the incidence of symptomatic events. Conclusion:Although risk assessment models and recommendations provided by consensus documents are of practical assistance, a decision concerning any patient is best made by combining recommendations of the literature with clinical judgment, including individual patient risk factors for thrombosis and bleeding.

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Thrombo-embolic prophylaxis in total knee replacement. Evaluation of the A-V Impulse System

Abstract: We performed a prospective randomised controlled trial of a new mechanical method of prophylaxis for venous thrombo-embolism in 60 patients undergoing knee replacement surgery. The method uses the A-V Impulse

Cited by 118 publications

References 0 publications

Prevention of VTE in Orthopedic Surgery Patients

Prevention of VTE in Orthopedic Surgery Patients

Cement as a risk factor for deep-vein thrombosis

Prevention of postoperative venous thromboembolism. Risk assessment and methods of prophylaxis

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