Abstract
Objective: To demonstrate the efficacy and safety of a multimodal stratified approach for prevention of thromboembolism in patients undergoing primary total hip arthroplasty. Method: A longitudinal retrospective clinical study of a cohort of 341 individuals undergoing total hip arthroplasty between March 2008 and July 2016. Of these, 242 patients met the criteria for inclusion in the study. Individuals with a history of deep vein thrombosis or pulmonary thromboembolism, thrombophilia, hypercoagulation conditions, and chronic users of anticoagulants before surgery received enoxaparin at a dose of 40 mg/day for 21 days. For the other group, acetylsalicylic acid was prescribed at a dose of 200 mg/day for 30 days. All patients had surgical risk assessed by the American Anesthesiology Association classified as I or II, and underwent regional anesthesia, effective hydration, the same protocol of early postoperative rehabilitation, and the use of compression stockings. Drug cost analysis was performed based on the Brasíndice. To date, there are no publications in PubMed and Scielo on this subject regarding the Brazilian population. Results: The need for blood transfusion in the enoxaparin group was higher and the overall complication and hemorrhagic rates were also significantly higher (p < 0.010) in this group. Aspirin prescription costs 39 times less than enoxaparin. Conclusion: In patients without predisposing factors to thromboembolism and undergoing primary total hip arthroplasty, the multimodal approach with acetylsalicylic acid seems to be effective, with low cost and a low rate of complications.
Highlights
Total hip arthroplasty (THA) is one of the surgical procedures with a high success rate in orthopedic surgery, eliminating pain and restoring hip function in osteoarthrosis cases [1]
The high incidence of complications in patients submitted to the American College of Chest Physicians (ACCP) protocol for the prevention of deep vein thrombosis (DVT)/pulmonary thromboembolism (PE) motivated the Academy of Orthopaedic Surgeons (AAOS) to propose new guidelines more appropriate to the orthopedic surgery scenario and its specifics, with the objective of preventing symptomatic PE and reducing the prevalence of DVT and, at the same time, minimizing the undesirable complications associated with more aggressive anticoagulation [12]
Johanson et al [14], in the guidelines recommended by the AAOS in 2009, affirm it is advisable to evaluate the risk of thromboembolic events, and of postoperative bleeding, and that mechanical prophylactic measures with early mobilization are recommended to all individuals who undergo hip or knee arthroplasties, without distinctions
Summary
Total hip arthroplasty (THA) is one of the surgical procedures with a high success rate in orthopedic surgery, eliminating pain and restoring hip function in osteoarthrosis cases [1]. The guidelines of the American College of Chest Physicians (ACCP) which emphasized prophylaxis with potent anticoagulant agents, did not modify the rate of symptomatic or fatal pulmonary thromboembolism over more than a decade. They increased morbidity in the major orthopedic surgery setting, mainly related to hemorrhagic complications, motivating the search and the proposal for alternative protocols [6]. Prophylaxis based on a set of mechanical measures and on the use of aspirin in patients who do not present risk factors for developing DVT and PE, has been gaining increasing credibility, anchored in large studies with high scientific impact, there is still no consensus about the best chemical agent for thromboprophylaxis after THA [10].
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