Thromboprophylaxis for Hip Revision Arthroplasty: Can We Use the Recommendations for Primary Hip Surgery? A Cohort Study

Abstract

The risk of thromboembolic events after hip revision arthroplasty might be higher than in primary hip arthroplasty. However, evidence regarding the use of thromboprophylaxis in revisions is scarce. The purpose of this study is to determine whether thromboprophylaxis recommendations for primary arthroplasty produce similar results in hip revision arthroplasty. This comparative cohort study retrospectively analyzed consecutive patients undergoing primary hip arthroplasty and hip revision surgery between March 2004 and December 2015, who received thromboprophylaxis according to local clinical practice guidelines for primary hip arthroplasty. The prevalence of deep vein thrombosis and pulmonary embolism and the presence of major bleeding events were assessed during hospitalization and at 3 months after discharge and compared between groups. The overall prevalence of thromboembolic events in the hip revision surgery cohort and in the primary hip cohort was 1.62% and 1.35%, respectively ( P = .801). The 38.4% of hip revision patients and 20.3% of primary hip patients presented major bleeding events. Thromboembolic disease outcomes with the use of a standardized thromboprophylaxis regimen were similar in both cohorts, regardless of the high variability of hip revision surgery and the increased risk of complications. Implementation of this regimen is recommended in patients requiring joint replacement revision surgery.

Effectiveness of Deep Venous Thrombosis Prevention in Total Hip Arthroplasty

“…21 It is worth emphasizing that the risk of VTE in revision arthroplasties is greater, as the magnitude and complexity of the procedure are considered to increase the risk of occurrence of this event. 12 We believe the use of the same protocol we used can determine the same positive results achieved in primary and revision THA. We did not observe any cases of DVT in the group of individuals undergoing revision THA.…”

“…In general, we found studies whose methods are similar to those adopted by Torres, Bautista and Lins, with incidences ranging from 0% to 3%. [10][11][12]…”

“…11 We found divergent opinions regarding the use of this protocol, as there is a fear that its application will not be enough to prevent DVT. 12 When consulting the literature, it is evident that it is not yet defined as to which drug agent actually has superiority in terms of collective efficacy and safety when compared to each other. 13 The use of enoxaparin (ENX), as well as other substances that act in the coagulation cascade, such as ASA, rivaroxaban (RVX), 14,15 Fondaparinux (FPX) or apixaban (APX), have been proven to reduce the incidence of VTE.…”

“…( 11 We found divergent opinions regarding the use of this protocol, as there is a fear that its application will not be enough to prevent DVT. ( 12 …”

Recommendations from the ICM-VTE: Hip & Knee

“…Predictors of VTE Events in Revision Arthroplasty Knee and Hip Surgery: Multiple studies have compared the incidence of VTE in primary and revision THA and TKA. Comparing direct VTE rates between revision and primary arthroplasty surgery, some studies have observed no difference in VTE rates [394][395][396][397] , some have observed a decreased incidence 394 , and others have observed an increased incidence [398][399][400] . In the studies that observed a higher incidence of VTE in revision vs. primary arthroplasty surgery, when the rates were adjusted for risk factors and comorbidities, revision surgery was either not associated with a higher risk of VTE 398 , or had a lower difference based on risk stratification 401 .…”