Is there not a better way to prevent venousthromboembolism after total knee arthroplasty?

Mark A Snyder,Oleg Vyrva

doi:10.15674/0030-59872017172-79

Abstract

Background: aspirin at 325 mg twice daily is now included as a nationally approved venous thromboembolism prophylaxis protocol for low risk total knee arthroplasty patients. The purpose of this study is to examine if there is a difference in deep vein thrombosis occurrence after a limited tourniquet total knee arthroplasty using aspirin-based prophylaxis with or without extended use of mechanical compression device therapy. Methods: one hundred limited tourniquet total knee arthroplasty patients, whose deep vein thrombosis risk was managed with aspirin 325 mg twice daily for 3 weeks, were randomized to either utilizing an mechanical compression device during hospitalization only or extended use at home up to six weeks post-op. Lower extremity Duplex venous ultrasonography was completed on the second post-op day, 14 days post-op, and at 3 months post-op to confirm absence of deep vein thrombosis after treatment. Results: the deep vein thrombosis rate for the post-discharge mechanical compression device therapy group was 0 % and 23.1 % for the inpatient mechanical compression device group (p < 0.001). All deep vein thrombosis resolved by 3 months postop. Patient satisfaction was 9.56 ± 0.82 for post-discharge mechanical compression device patients versus 8.50 ± 1.46 for in patient mechanical compression device patients (p < 0.001). Conclusion: limited tourniquet total knee arthroplasty patients that were mobilized early, managed with Aspirin for 3 weeks post-op, and mechanical compression device therapy for up to 6 weeks post-op experienced superior deep vein thrombosis prophylaxis than patients receiving mechanical compression device therapy only as an inpatient (p < 0.05). The 0 % incidence of non-symptomatic deep vein thrombosis prevented by Aspirin and extended use mechanical compression device further validates this type of prophylaxis in low deep vein thrombosis risk total knee arthroplasty patients.

Highlights

Among total joint surgery complications, the risk of venous thromboembolism (VTE) is of the utmost concern warranting VTE prophylaxis in even low risk patients
Patients undergoing total knee arthroplasty (TKA) are at risk for VTE with an incidence rate of 17–53 % depending on the method of prevention [1] therein warranting routine prevention in even low-risk patients [2,3,4,5,6,7]
Standard of care guidelines implemented by the American Academy of Orthopedic Surgeons (AAOS) has mandated a re gimen of thromboprophylaxis for all total hip or knee replacement patients, and has outlined those regimens with updated research evidence, taking into account the patient’s history and risk of thrombosis [2]

Summary

Introduction

Among total joint surgery complications, the risk of venous thromboembolism (VTE) is of the utmost concern warranting VTE prophylaxis in even low risk patients. The 2014 guidelines on VTE management are the result of the Surgical Care Improvement Project (SCIP), a national partnership of organizations including the Joint Commission and the Centers for Medicare and Medicaid Services, with the goal of redu cing surgical complications and publishing a uniform set of national hospital quality measures. This goal is currently limited by the lack of conclusive evidence that would allow the endorsement of one regimen over another, and so the prevention method of choice remains controversial [2]. The conflicting evidence is well documented in the AAOS Guidelines citing such reasons as lack of standardized drug doses, unstandardized routes of administration, un-standardi zed durations of therapy, a dearth of placebo cont rolled studies, as well as nonrepresentative research populations, or underpowered studies [2]

Objectives

Methods

Results