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Study supports use of mobile compression devices as VTE prophylaxis after TJA
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ORLANDO, Fla. — Findings presented at the Current Concepts in Joint Replacement Winter Meeting indicated that the use of mobile pneumatic compression devices based on a risk stratification protocol can be an effective means of venous thromboembolic prophylaxis after total joint arthroplasty and allows most patients to avoid aggressive anticoagulants.
Denis Nam, MD, and colleagues performed a 4-year study in which they stratified patients who underwent total joint arthroplasty as either routine or high risk for venous thromboembolic (VTE) events. Patients in the routine cohort used a 1.65-pound, battery-powered, mobile pneumatic compression device for 10 days and received aspirin for 6 weeks. Patients in the high risk cohort received warfarin.
For the first phase of the study, investigators used patient age, history of VTE, active cancer, hypercoagulable state, multiple medical comorbidities, obesity and a family history of thrombosis as risk factors for inclusion in the high risk cohort. For the second phase of the study, investigators modified the criteria and removed age, multiple medical comorbidities and BMI in an effort to avoid the use of warfarin in more patients. Phase 1 of the study included 3,143 patients, of which 43% were deemed high risk. Using the modified inclusion criteria, this figure decreased to 17% for phase 2 of the study.
Denis Nam
Investigators found no significant difference in the VTE rates between the study phases when they compared the routine cohorts against each other and the high risk cohorts with each other. When investigators analyzed their results for deep vein thrombosis and pulmonary embolism, they found no significant difference in the rate of VTE events at 6 weeks in either cohort.
“However, there was an increased rate of major bleeding complications in the high risk cohort receiving warfarin, along with increased wound problems and also increased days of drainage when receiving warfarin vs. aspirin and mechanical compression devices,” Nam said, here.
Researchers also found better patient satisfaction in the routine cohort.
“We found that use of a risk stratification protocol has allowed the avoidance of more aggressive anticoagulation in 70% of our patients while still achieving a low overall incidence of symptomatic VTE,” Nam said, noting the big remaining question is whether aspirin is necessary or whether aspirin alone is sufficient.
He added, “I would avoid aggressive anticoagulation when possible due to other perioperative morbidity associated with chemical prophylaxis, and I believe [mobile compression devices] MCDs are an effective method or adjunct for VTE prophylaxis following total joint arthroplasty.” – by Gina Brockenbrough, MA
Reference:
Nam D. Paper #39. Presented at: the Current Concepts in Joint Replacement Winter Meeting; Dec. 9-12, 2015; Orlando, Fla.
Disclosure: Nam reports he receives research support from EOS and consulting fees for speaking and teaching from KCI/Acelity, and has stock options in OrthAlign Inc.