Multimodal Stratified Approach for Prevention of Thromboembolism in Patients Undergoing Total Hip Arthroplasty

Objective: To demonstrate the efficacy and safety of a multimodal stratified approach for prevention of thromboembolism in patients undergoing primary total hip arthroplasty. Method: A longitudinal retrospective clinical study of a cohort of 341 individuals undergoing total hip arthroplasty between March 2008 and July 2016. Of these, 242 patients met the criteria for inclusion in the study. Individuals with a history of deep vein thrombosis or pulmonary thromboembolism, thrombophilia, hypercoagulation conditions, and chronic users of anticoagulants before surgery received enoxaparin at a dose of 40 mg/day for 21 days. For the other group, acetylsalicylic acid was prescribed at a dose of 200 mg/day for 30 days. All patients had surgical risk assessed by the American Anesthesiology Association classified as I or II, and underwent regional anesthesia, effective hydration, the same protocol of early postoperative rehabilitation, and the use of compression stockings. Drug cost analysis was performed based on the Brasindice. To date, there are no publications in PubMed and Scielo on this subject regarding the Brazilian population. Results: The need for blood transfusion in the enoxaparin group was higher and the overall complication and hemorrhagic rates were also significantly higher (p < 0.010) in this group. Aspirin prescription costs 39 times less than enoxaparin. Conclusion: In patients without predisposing factors to thromboembolism and undergoing primary total hip arthroplasty, the multimodal approach with acetylsalicylic acid seems to be effective, with low cost and a low rate of complications.

[1]  P. Howard,et al.  Fatal pulmonary embolism following elective total hip arthroplasty: a 12-year study. , 2016, The bone & joint journal.

[2]  D. Beverland,et al.  Aspirin for thromboprophylaxis after primary lower limb arthroplasty: early thromboembolic events and 90 day mortality in 11,459 patients. , 2016, The bone & joint journal.

[3]  J. Scolaro,et al.  Venous Thromboembolism in Orthopaedic Trauma , 2015, The Journal of the American Academy of Orthopaedic Surgeons.

[4]  Ibrahim J. Raphael,et al.  Aspirin: An Alternative for Pulmonary Embolism Prophylaxis After Arthroplasty? , 2014, Clinical orthopaedics and related research.

[5]  D. Giannarelli,et al.  Prevention of VTE in orthopedic surgery patients , 2013 .

[6]  J. Parvizi,et al.  Prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty. , 2009, The Journal of the American Academy of Orthopaedic Surgeons.

[7]  J. Parvizi,et al.  Deep venous thrombosis prophylaxis for total joint arthroplasty: American Academy of Orthopaedic Surgeons guidelines. , 2008, The Journal of arthroplasty.

[8]  J. Callaghan,et al.  Evaluation of deep venous thrombosis prophylaxis in low-risk patients undergoing total knee arthroplasty. , 2008, The Journal of arthroplasty.

[9]  G. Raskob,et al.  Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). , 2008, Chest.

[10]  Clifford W Colwell,et al.  Prevention of Venous Thromboembolism* American College of Chest Physicians Evidence- Based Clinical Practice Guidelines (8th Edition) , 2008 .

[11]  E. Salvati,et al.  Potent Anticoagulants are Associated with a Higher All-Cause Mortality Rate After Hip and Knee Arthroplasty , 2008, Clinical orthopaedics and related research.

[12]  L. Dorr,et al.  Multimodal thromboprophylaxis for total hip and knee arthroplasty based on risk assessment. , 2007, The Journal of bone and joint surgery. American volume.

[13]  J. Parvizi,et al.  Does "excessive" anticoagulation predispose to periprosthetic infection? , 2007, The Journal of arthroplasty.

[14]  H. Potter,et al.  The 2007 ABJS Nicolas Andry Award: three decades of clinical, basic, and applied research on thromboembolic disease after THA: rationale and clinical results of a multimodal prophylaxis protocol. , 2007, Clinical orthopaedics and related research.

[15]  R. Barrack,et al.  Failure of the American College of Chest Physicians-1A protocol for lovenox in clinical outcomes for thromboembolic prophylaxis. , 2007, The Journal of arthroplasty.

[16]  P. Lachiewicz,et al.  Multimodal Prophylaxis for THA with Mechanical Compression , 2006, Clinical orthopaedics and related research.

[17]  E. Salvati,et al.  Venous Thromboembolism Is Rare with a Multimodal Prophylaxis Protocol after Total Hip Arthroplasty , 2006, Clinical orthopaedics and related research.

[18]  Clifford W Colwell,et al.  Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. , 2004, Chest.

[19]  J. Kuehle,et al.  Mechanical prophylaxis of deep-vein thrombosis after total hip replacement a randomised clinical trial. , 2004, The Journal of bone and joint surgery. British volume.

[20]  J. Danesh,et al.  Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial , 2000, The Lancet.

[21]  R. Atkinson,et al.  Bleeding complications with enoxaparin for deep venous thrombosis prophylaxis. , 1999, The Journal of arthroplasty.

[22]  A Laupacis,et al.  The effect of elective total hip replacement on health-related quality of life. , 1993, The Journal of bone and joint surgery. American volume.

[23]  S. Goldhaber,et al.  Complications of heparin therapy after total joint arthroplasty. , 1990, The Journal of bone and joint surgery. American volume.

[24]  M. Pearcy.  A new generation of artificial hip joints. , 1988, Engineering in medicine.

[25]  R. Aaron,et al.  Venous thromboembolism in the orthopedic patient. , 1983, The Surgical clinics of North America.

[26]  K. Hardinge.  The direct lateral approach to the hip. , 1982, The Journal of bone and joint surgery. British volume.

[27]  I. Leite,et al.  Análise da qualidade de vida de pacientes osteoartrósicos submetidos à artroplastia total do quadril , 2012 .

[28]  P. D. Di Cesare,et al.  Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty. , 2007, The Journal of bone and joint surgery. American volume.

[29]  S. Leite,et al.  Adesão à terapêutica medicamentosa: elementos para a discussão de conceitos e pressupostos adotados na literatura , 2003 .

[30]  G. Paiement,et al.  The risk of venous thromboembolism in the orthopedic patient: epidemiological and physiological data. , 1997, Orthopedics.

[31]  Rd Dripps,et al.  New classification of physical status , 1963 .