Unfractionated heparin and mechanical thromboprophylaxis in hip arthroplasty

Abstract

OBJECTIVE: To evaluate the efficacy and safety of unfractionated heparin associated with mechanical prophylaxis as a method for preventing venous thromboembolism in hip arthroplasty. METHOD: We retrospectively reviewed the records of 181 hip arthroplasties out of 216 consecutive cases performed over a period of 39 months in our hospital. We excluded 35 cases due to non-adherence to the standardized method of thromboprophylaxis or loss to follow-up. All arthroplasties evaluated completed one-year follow-up after surgery with five consultations at predefined periods. Efficacy of the proposed method was evaluated by the occurrence of symptomatic venous thromboembolism confirmed by specific tests and safety was determined by the lack of occurrence of major bleeding according to criteria established by the International Society on Thrombosis and Haemostasis. RESULTS: There were four cases of symptomatic venous thromboembolism (2.2%), with three cases of deep vein thrombosis (1.65%) and one case of pulmonary embolism (0.55%). We found one case of severe bleeding (0.55%). CONCLUSION: Unfractionated heparin associated with mechanical prophylaxis proved to be an effective and safe method for preventing venous thromboembolism in patients undergoing hip arthroplasty, presenting rates of thromboembolic complications and major bleeding within the range reported with other methods currently used of thromboprophylaxis. Level of Evidence IV, Case Series

Effect of Nursing Care Standards for Preventing Deep Vein Thrombosis among Patients Undergoing Hip Surgery on Nurses' Performance and Patients' Outcome

“…The incidence of asymptomatic DVT after a major orthopedic surgery without prophylaxis reportedly ranges from 30% to 80% whereas the incidence of symptomatic DVT reportedly ranges from 0.5% to 4%. About 40-50% of untreated symptomatic DVT patients will develop a PE within 3 months and 10% of symptomatic PE cases will die within 1 hour of onset [3] .In Egypt, a study conducted at El-Hadara orthopedic and traumatology university hospital in Alexandria in 2005 for development of an assessment scale for patients at risk of DVT reported 14% incidence of DVT among lower limb orthopedic patients after one month follow up period post discharge [4] . The DVT is a common and potentially lethal disease which leads to severe morbidity with poor quality of life and even sudden death related to PE.…”