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AAOS guidelines for prophylaxis of thromboembolic events minimize adverse outcomes
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Use of the first-generation American Academy of Orthopaedic Surgeons guidelines gave rise to low incidence of clinically important thromboembolic events in total hip and total knee arthroplasty patients and effectively minimized adverse outcomes, according to study results.
Researchers analyzed data on age, sex, body mass index, American Society for Anesthesiologists classification, and a personal or family history of blood clots requiring long-term warfarin among 3,289 patients managed with total hip or total knee arthroplasty (THA, TKA). Data were also analyzed on a personal history of a malignant tumor, bleeding disorder, gastrointestinal bleeding or a hemorrhagic cerebrovascular accident.
The researchers managed all patients prophylactically with a specific algorithm based on the American Academy of Orthopaedic Surgeons guidelines. On postoperative day 1, all patients were mobilized and pneumatic foot-pump compression was used for the duration of the hospitalization.
Using Doppler ultrasound or CT angiography, the researchers documented 36 major venous thromboembolic events for a 90-day incidence of 1.1%. Although study results showed a significant association between a personal history of blood clots and a blood clot in the proximal part of the thigh or a pulmonary embolism, a family history of blood clots and a personal history of malignant tumor did not show a significant relationship with venous thromboembolism, according to the researchers.
The researchers found there was a significant difference in 90-day incidence of venous thromboembolism between THA and TKA patients, with a greater risk among high-risk TKA patients vs. high-risk THA patients despite comparable prophylaxis with enoxaparin sodium for 28 days.
Disclosure: The authors have no relevant financial disclosures.
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