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Prevention of Thromboembolism After Hip Surgery

In the U.S. most surgeons use heparin or warfarin to prevent thromboembolism after total hip arthroplasty (THA). This retrospective study of 1,267 patients undergoing 1,492 THAs (all done by a single surgeon) examines the risk for thromboembolism without the use of those agents. All patients had THA through a posterior approach and the following interventions: passive leg exercises intraoperatively, active exercises postoperatively, graded elastic stockings or intermittent compression devices, early ambulation after surgery, and aspirin (a 600-mg suppository postoperatively and 325 mg twice daily until discharge).

During a three-month follow-up, two patients (0.13 percent) had fatal pulmonary embolism (PE), 14 (0.94 percent) had symptomatic nonfatal PE, and 15 (1 percent) had symptomatic deep venous thrombosis (DVT). The incidence of PE and DVT was significantly lower in the 74 percent of patients who had regional anesthesia than in those who had general anesthesia. Patients were not screened for asymptomatic DVT.

Comment: In a study like this, one must be concerned about whether all symptomatic cases of PE and DVT were documented. Nevertheless, the results suggest that a multifaceted approach (including exercises, mechanical compression, aspirin, and use of regional anesthesia when possible) may be as effective as more expensive and more complicated drug regimens.

— AS Brett

Published in Journal Watch General Medicine April 13, 1999

Citation(s):

Sarmiento A and Goswami ADK. Thromboembolic prophylaxis with use of aspirin, exercise, and graded elastic stockings or intermittent compression devices in patients managed with total hip arthroplasty. J Bone Joint Surg Am 1999 Mar 81 339-346.

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