Key result
Multimodal thromboprophylaxis in patients with a history of VTE undergoing total hip arthroplasty was associated with a 2.5% rate of postoperative VTE at 120 days and 2.5% mortality at 1 year.
Why the study?
Does multimodal thromboprophylaxis prevent postoperative VTE and mortality in patients with a history of VTE undergoing primary elective hip arthroplasty?
Cohort (n=257)
No
Does multimodal thromboprophylaxis prevent postoperative VTE and mortality in patients with a history of VTE undergoing primary elective hip arthroplasty?
A multimodal thromboprophylaxis strategy in high-risk patients with a history of VTE undergoing total hip arthroplasty is associated with a low rate of recurrent VTE (2.5%) and 1-year mortality (2.5%).
Low VTE rates with multimodal prophylaxis in high-risk THA patients should not yet change practice; leaves open need for randomized comparisons.
AIMS: We studied the safety and efficacy of multimodal thromboprophylaxis in patients with a history of venous thromboembolism (VTE) who undergo total hip arthroplasty (THA) within the first 120 postoperative days, and the mortality during the first year. Multimodal prophylaxis includes discontinuation of procoagulant medications, VTE risk stratification, regional anaesthesia, an intravenous bolus of unfractionated heparin prior to femoral preparation, rapid mobilization, the use of pneumatic compression devices, and chemoprophylaxis tailored to the patient's risk of VTE. METHODS: Between 2004 to 2018, 257 patients with a proven history of VTE underwent 277 primary elective THA procedures by two surgeons at a single institution. The patients had a history of deep vein thrombosis (DVT) (186, 67%), pulmonary embolism (PE) (43, 15.5%), or both (48, 17.5%). Chemoprophylaxis included aspirin (38 patients), anticoagulation (215 patients), or a combination of aspirin and anticoagulation (24 patients). A total of 50 patients (18%) had a vena cava filter in situ at the time of surgery. Patients were followed for 120 days to record complications, and for one year to record mortality. RESULTS: Postoperative VTE was diagnosed in seven patients (2.5%): DVT in five, and PE with and without DVT in one patient each. After hospitalization, three patients required readmiss-ion for evacuation of a haematoma, one for wound drainage, and one for monitoring of an elevated international normalized ratio (INR). Seven patients died (2.5%). One patient died five months postoperatively of a PE during open thrombectomy. She had discontinued anticoagulation. One patient died of a haemorrhagic stroke while receiving Coumadin. PE or bleeding was not suspected in the remaining five fatalities. CONCLUSION: 2020;102-B(7 Supple B):71-77.
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Valle et al. (2020) conducted a cohort in History of venous thromboembolism undergoing primary elective hip arthroplasty (n=257). Multimodal thromboprophylaxis was evaluated on Postoperative venous thromboembolism within 120 days. Multimodal thromboprophylaxis in patients with a history of VTE undergoing total hip arthroplasty was associated with a 2.5% rate of postoperative VTE at 120 days and 2.5% mortality at 1 year.
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