Thrombocytopenia and Intra-cerebral Complications Associated with Low-Molecular-Weight Heparin Treatment in Patients Undergoing Total Hip Replacement: A Report of Two Cases

Lilikakis, A.; Papapolychroniou, Theodoros; Macheras, Georgios; Michelinakis, E.

doi:10.2106/jbjs.e.00121

Cited by 9 publications

(6 citation statements)

References 34 publications

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“…95 Successful therapy requires immediate cessation of heparin, and if not promptly recognized, antibody-mediated thrombocytopenia carries a 40% mortality rate. 40,60,95 Anticoagulation-induced persistent wound drainage and hematoma are associated with a higher prevalence of wound infection. 57,72 These concerns prompted leaders in joint replacement surgery to publish a recent editorial recommending caution in the extensive use of LMWH.…”

Section: Pharmacologic Prophylaxis In the Postoperative Periodmentioning

confidence: 99%

The 2007 ABJS Nicolas Andry Award: Three Decades of Clinical, Basic, and Applied Research on Thromboembolic Disease after THA

Salvati¹,

Sharrock²,

Westrich³

et al. 2007

Clinical Orthopaedics &Amp; Related Research

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Total hip arthroplasty is an operation with a high risk for venous thromboembolism. Three decades of research conducted at the Hospital for Special Surgery identified the exact timing of the thrombogenic stimulus during surgery, defined the role of magnetic resonance venography, and established the role of certain genetic and acquired predispositions. Based on these studies, we implemented a multimodal prophylaxis consisting of a series of safe preventive measures applied before, during, and immediately after surgery to reduce the risk of venous thromboembolism. If these safe preventive measures are strictly observed, postoperative pharmacologic prophylaxis does not need to be aggressive in the patient without predisposing factors who mobilizes promptly, thus diminishing the risk of bleeding associated with the use of anticoagulants and the overall cost of care. Our clinical experience with more than 5000 total hip arthroplasties performed during the last decade and closely followed prospectively for a minimum of 3 months clearly shows this multimodal prophylaxis is safe and effective resulting in a very low prevalence of thromboembolism.

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Section: Pharmacologic Prophylaxis In the Postoperative Periodmentioning

confidence: 99%

The 2007 ABJS Nicolas Andry Award: Three Decades of Clinical, Basic, and Applied Research on Thromboembolic Disease after THA

Salvati¹,

Sharrock²,

Westrich³

et al. 2007

Clinical Orthopaedics &Amp; Related Research

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“…Despite the increased use of anticoagulants for thromboprophylaxis, the mortality of patients undergoing THA has remained constant during the last decade [23]. Therefore, the use of aggressive anticoagulation is questionable [5] as these agents have potential lifethreatening side effects from systemic and local bleeding complications [24][25][26][27][28][29]. Murray et al [30] performed a metaanalysis of all studies on hip replacement which included information about death or fatal pulmonary embolism.…”

Section: Discussionmentioning

confidence: 99%

Risk Factor Analysis for 30-Day Mortality after Primary THA in a Single Institution

Hidalgo¹,

Buttaro²,

Piccaluga³

2012

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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The purpose of this study was to determine the prevalence of, and associated risk factors for, 30-day perioperative death following primary total hip arthroplasty (THA). Data of all the patients were compiled from the computerized total joint registry at a single institution. Between May 1993 and May 2006, 3,232 consecutive primary THA (2,453 elective and 779 nonelective) were performed. Eleven deaths occurred during the first month after surgery (0.34 %). Thirty-day mortality rate after elective THA was 0.08 % (two of 2,453 IC 95 %(0-0.4)). The 30-day mortality rate after nonelective THA was 1.15 % (nine of 779 IC 95 %(0.7-2.4). To analyze the factors that could have contributed with death, we conducted a 4-to-1 nested case-control study. Control cases were strictly matched by sex, age, surgeon, prosthesis fixation mode, and date of surgery. Conditional logistic regression was used to evaluate the association of risk factors with mortality. Elective surgery was associated with a lower risk of mortality with an odds ratio (OR) of 0.07 (95 % CI 0.008-0.6);p = 0.015. American Society of Anesthesiologists (ASA) score III-IV increased the mortality risk 13 times (OR 13.7; 95 % CI 1.6-114.8). Cardiovascular disease increased the risk for mortality eight times (OR 8.83 (95 % CI 1.78-43.6). Time delay before surgery showed a trend towards significance (p = 0.06). Aggressive vs. nonaggressive thromboembolism prophylaxis and the amount of blood transfusions required were not associated with a higher risk of death. Patients undergoing a THA due to fractures, patients with high ASA score, and those with cardiovascular disease were the highest risk factors for 30-day mortality after primary THA.

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“…21, 67, 93, 94, 106 Although HIT and its associated risk for paradoxical thrombotic disease, limb amputation, and death, represents an example of one of the most severe complications of VTED chemoprophylaxsis, only 15 papers have been published in the English orthopedic literature focusing on this disease. These case reports discuss less than a total of 30 cases, and do not differentiate between Type I and Type II disease, 4,6,7,9,17,20–22,31,40,42,47,56,57,63–68,70,74a,75,76,93,94,106,108,111,114 Collectively, these clinical accounts provide at best for only Level IV evidence on this issue. A meta-analysis of these scattered orthopaedic publications identified an estimated 22% amputation rate, 11% mortality rate, and 33% major complication rate with HIT.…”

Section: Background and Incidencementioning

confidence: 99%

“…A meta-analysis of these scattered orthopaedic publications identified an estimated 22% amputation rate, 11% mortality rate, and 33% major complication rate with HIT. 6,7,9,17,42,47,56,64,65,68,70,74a,75,76,93,94 Although there are no known published reports of immune-mediated HIT in an orthopedic patient after a singular exposure to heparin or its derivatives, this author has observed a patient die of systemic complications related to HIT approximately one month after a single perioperative injection with a LMWH as prophylaxsis for a foot and ankle procedure. 50,67,106,109…”

Section: Background and Incidencementioning

confidence: 99%

Current Concepts Review: Heparin-Induced Thrombocytopenia

DiGiovanni

2008

Foot Ankle Int.

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Thrombocytopenia and Intra-cerebral Complications Associated with Low-Molecular-Weight Heparin Treatment in Patients Undergoing Total Hip Replacement: A Report of Two Cases

Cited by 9 publications

References 34 publications

The 2007 ABJS Nicolas Andry Award: Three Decades of Clinical, Basic, and Applied Research on Thromboembolic Disease after THA

The 2007 ABJS Nicolas Andry Award: Three Decades of Clinical, Basic, and Applied Research on Thromboembolic Disease after THA

Risk Factor Analysis for 30-Day Mortality after Primary THA in a Single Institution

Current Concepts Review: Heparin-Induced Thrombocytopenia

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