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Mobile compression device superior to warfarin in preventing major bleeding events after THA, TKA
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A mobile compression device is similarly effective to warfarin in the prevention of venous thrombembolic events following total hip or knee arthroplasty — but significantly better in preventing major bleeding events, according to researchers from St. Louis.
“Venous thrombotic embolism (VTE), certainly DVT (deep vein thrombosis) and PE (pulmonary embolism), are major complications associated with hip and knee surgery,” Ryan Nunley, MD, said in his presentation at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. “There’s certainly some controversy as to the appropriate prophylaxis, and as we start looking at health care reform … we have concerns about major bleeding events.”
According to Nunley, 495 joint procedures — 275 total hip arthroplasties (THAs) and 220 total knee arthroplasties (TKAs) — were examined prospectively, with exclusion criteria including prior surgery within 3 months, current DVT and history of PE.
The cohort was split into two groups. The first, a standard risk anticoagulation therapy group of 289 patients, received a mobile compression device for 10 days with aspirin therapy for 6 weeks postoperatively. The second, a high risk group of 206 patients, received warfarin for 4 weeks and a compression stocking for 6 weeks postoperatively. Bleeding complications, symptomatic VTEs and hospital readmissions were all monitored for 6 months postoperatively.
According to the study results, distal and proximal DVT risk was 0.7% in the standard risk group and 1% in the high risk group, with PE rates of 0.3% in the standard risk group and 0.5% in the high risk group. Major bleeding events were found to be significantly lower in the standard risk group than in the high risk group (0.9% vs. 4.5%, respectively).
“The use of our mobile pumps and aspirin seemed to have an equivocal rate of [VTE] compared to [warfarin] and compression hose,” Nunley said. “Patients with mobile pumps had significantly lower rates of bleeding and complication, which will be important for readmission and surgeon data. We continue to enroll patients to determine if some of these other trends will be significant with time in larger patient cohorts.”
Reference:
- Barrack RL, Nunley R, Clohisy JC, et al. Incidence of symptomatic DVT/PE and bleeding complications following knee and hip arthroplasty. Paper 269. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
- Disclosure: Nunley receives research support from Biomet, Wright Medical Technology Inc., Stryker, Smith & Nephew, EOS Imaging, and Medical Compression Systems.
