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Low-intensity warfarin reduces bleeding, symptomatic venous thromboembolism after THA
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Researchers in this study reported low rates of symptomatic venous thromboembolism and clinically relevant bleeding 90 days after using low-intensity warfarin for 6 weeks after total hip arthroplasty.
“Although warfarin produced low rates of clinically relevant bleeding and symptomatic venous thromboembolism, pulmonary embolism made up a greater proportion of events than anticipated,” the researchers wrote in the study abstract. “Low-intensity warfarin should be considered in future studies to identify the regimen that optimally balances risk of bleeding and symptomatic venous thromboembolism in a real world setting.”
In 81.1% of the 800 patients analyzed, mechanical prophylaxis was prescribed in addition to warfarin, according to the abstract. Although there were only 13 (1.6%) cases of symptomatic venous thromboembolism, 10 (1.3%) cases were pulmonary embolism, the researchers noted. Clinically relevant bleeding occurred in 0.8% of cases and one unrelated death was reported.
Disclosure: The authors have no relevant financial disclosures.
Perspective
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Harry S. Jacob, MD, FRCPath(Hon)
The rather astonishing rate of embolization of the few thrombi that form under conditions of effete anticoagulation is intriguing. It suggests that partially inhibited clots may be friable and potentially of greater damage than ‘more complete’ clots. Unless further studies demonstrate significant decreases in major bleeding with a low-dose regimen, I believe it should not become standard prophylaxis. This scenario may also provide insight into the known deep vein thrombosis/pulmonary embolism suffered by hemophiliacs after arthroplasties (Stein MI. Orthopedics. 2011;34:393).
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