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Multimodal approach to DVT prevention is successful in low-risk TKA patients
Aspirin plus mechanical prophylaxis resulted in a 1% postoperative DVT rate and no deaths due to thrombosis or pulmonary emboli.
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ASHEVILLE, N.C. — A multimodal approach to deep venous thrombosis prevention involving aspirin and mechanical prophylaxis has been successful in a low-risk patient population undergoing total knee arthroplasty, according to a study presented here.
In a prospective review of 430 consecutive total knee arthroplasties (TKAs) that he performed, John J. Callaghan, MD, compared the prophylaxis methods he used in two groups of patients: a high-risk group and a low-risk group. The high-risk group included 76 patients with a history of deep venous thrombosis (DVT), venous stasis, chronic Coumadin [warfarin, Bristol-Myers Squibb] use, or who underwent a bilateral procedure. The low-risk group included 253 patients who did not have those risks.
Callaghan, who presented his data as a Special Emphasis Poster at the 120th Annual Meeting of the American Orthopaedic Association, said the optimal DVT prophylaxis following TKA is controversial, especially in light of the published Chest guidelines. "Our hospitals right now are trying to dictate what we do," he said.
The DVT prophylaxis for the low-risk patients involved early ambulation, thromboembolic disease hose, foot pumps and 325 mg Enteric-coated aspirin per day for 6 weeks. The high-risk group received the same treatment, except they received warfarin in place of the aspirin.
Callaghan and colleagues evaluated routine pre-discharge Duplex scans performed on the low-risk patients to document the efficacy of the routine use of aspirin and mechanical prophylaxes in these patients.
Overall investigators found a 0.7% rate of distal DVT and a 1.3% rate of proximal DVT in the low-risk group at 3 to 7 days postop. Also, two symptomatic DVTs formed at 44 and 53 days postop in two patients who showed no signs of DVT on the pre-discharge Doppler.
Doppler scans were not performed on the high-risk group, but two patients in the group died due to cardiac complications and two had readmission for DVT-related events within 90 days postop.
"There were no deaths in the low-risk group," Callaghan said.
For more information:
- Callaghan JJ, Warth L, Hoballah JJ, et al. Evaluation of DVT prophylaxis in low risk patients undergoing TKA. Poster AR-2. Presented at the 120th meeting of the American Orthopaedic Association. June 14, 2007. Asheville, N.C. Dr. Callaghan has indicated that he has received institutional support and royalties from DePuy.