Prolonged Prophylaxis after Joint Replacement: Another Step Sideways?

Editorials6 June 2000Prolonged Prophylaxis after Joint Replacement: Another Step Sideways?Bruce L. Davidson, MD, MPH and Anthonie W.A. Lensing, MD, PhDBruce L. Davidson, MD, MPHSearch for more papers by this author and Anthonie W.A. Lensing, MD, PhDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-132-11-200006060-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail It is generally accepted that perioperative prophylaxis against venous thromboembolism is important for patients undergoing hip and knee replacement. Even before shortened hospitalizations, there was a tendency to extend prophylaxis into the outpatient setting. If prolonged prophylaxis after joint replacement were proven safe and effective for preventing not only clots but their clinical sequelae and were also convenient and inexpensive, it would not be controversial. Unfortunately, this is not the case.Strong clinical evidence supports the safety and effectiveness of low-molecular-weight heparin in preventing venographically demonstrable thrombosis in patients undergoing hip replacement; incidence is reduced by approximately 50% (1-6). Any ...References1. Planes A, Vochelle N, Darmon JY, Fagola M, Bellaud M, Huet Y. Risk of deep-venous thrombosis after hospital discharge in patients having undergone total hip replacement: double-blind randomised comparison of enoxaparin versus placebo. Lancet. 1996;348:224-8. CrossrefMedlineGoogle Scholar2. Bergqvist D, Benoni G, Bjorgell O, Fredin H, Hedlundh U, Nicolas S, et al . Low-molecular-weight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement. N Engl J Med. 1996;335:696-700. CrossrefMedlineGoogle Scholar3. Dahl OE, Andreassen G, Aspelin T, Muller C, Mathiesen P, Nyhus S, et al . Prolonged thromboprophylaxis following hip replacement surgery—results of a double-blind, prospective, randomised, placebo-controlled study with dalteparin. Thromb Haemost. 1997;77:26-31. CrossrefMedlineGoogle Scholar4. Lassen MR, Borris LC, Anderson BS, Jensen HP, Skejo Bro HP, Andersen G, et al . Efficacy and safety of prolonged thromboprophylaxis with a low molecular weight heparin (dalteparin) after total hip arthroplasty—the Danish Prolonged Prophylaxis (DaPP) Study. Thromb Res. 1998;89:281-7. CrossrefMedlineGoogle Scholar5. Spiro TE. A double-blind multicenter clinical trial comparing long term enoxaparin and placebo treatments in the prevention of venous thromboembolic disease after hip and knee replacement surgery [Abstract]. The Enoxaparin Clinical Trial Group. Blood. 1997;90 Suppl 295a. Google Scholar6. Hull RD, Pineo GF. A double-blind randomized comparison of extended out-of-hospital prophylaxis using dalteparin versus placebo in patients undergoing elective hip replacement [Abstract]. Thromb Haemost. 1999;17 Suppl 6. Google Scholar7. Heit JA, Elliott CG, Trowbridge AA, Morrey BF, Gent M, Hirsh J. Ardeparin sodium for extended out-of-hospital prophylaxis against venous thromboembolism after total hip or knee replacement. A randomized, double-blind, placebo-controlled trial. The Ardeparin Arthroplasty Study Group. Ann Intern Med. 2000;132:853-61. LinkGoogle Scholar8. RD Heparin Arthroplasty Group. RD heparin compared with warfarin for prevention of venous thromboembolic disease following total hip or knee arthroplasty. J Bone Joint Surg Am. 1994;76:1174-85. CrossrefMedlineGoogle Scholar9. Samama MM, Cohen AT, Darmon JY, Desjardins L, Eldor A, Janbon C, et al . A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in Medical Patients with Enoxaparin Study Group. N Engl J Med. 1999;341:793-800. CrossrefMedlineGoogle Scholar10. Hull R, Raskob G, Pineo G, Rosenbloom D, Evans W, Mallory T, et al . A comparison of subcutaneous low-molecular-weight heparin with warfarin sodium for prophylaxis against deep-vein thrombosis after hip or knee implantation. N Engl J Med. 1993;329:1370-6. CrossrefMedlineGoogle Scholar11. Vorchheimer DA, Badimon JJ, Fuster V. Platelet glycoprotein IIb/IIIa receptor antagonists in cardiovascular disease. JAMA. 1999;281:1407-14. CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Note: Dr. Davidson is a consultant to companies that are developing antithrombotic drugs and is an investigator in clinical trials of these drugs. Funds generated by these activities go to Dr. Davidson's institution. Dr. Lensing is employed part-time by Organon Akzo Nobel, a company that produces antithrombotic and other types of drugs. He receives salary but not stock for this work.Current Author Addresses: Dr. Davidson: Pulmonary–Critical Care Medicine Section (C7-PUL), Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98101.Dr. Lensing: Division of Vascular Medicine, Academic Medical Center, Meibergdreef 9, Box 22660, Amsterdam, the Netherlands. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoArdeparin Sodium for Extended Out-of-Hospital Prophylaxis against Venous Thromboembolism after Total Hip or Knee Replacement John A. Heit , C. Gregory Elliott , Arthur A. Trowbridge , Bernard F. Morrey , Michael Gent , Jack Hirsh , and Metrics Cited ByThe Post-thrombotic Syndrome: The Forgotten Morbidity of Deep Venous ThrombosisThe post-thrombotic syndrome: current knowledge, controversies, and directions for future researchExtended Out-of-Hospital Low-Molecular-Weight Heparin Prophylaxis against Deep Venous Thrombosis in Patients after Elective Hip Arthroplasty A Systematic ReviewRussell D. Hull, MBBS, MSc, Graham F. Pineo, MD, Paul D. Stein, MD, Andrew F. Mah, BSc, Susan M. MacIsaac, MSc, Ola E. Dahl, MD, PhD, Matthew Butcher, BSc, Rollin F. Brant, PhD, William A. Ghali, MD, MPH, David Bergqvist, MD, PhD, and Gary E. Raskob, PhDExtended-duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of the randomised trials 6 June 2000Volume 132, Issue 11Page: 914-915KeywordsDrugsHipJoint replacement surgeryKneesLow molecular weight heparinOutpatientsProphylaxisSodiumThrombosisVenous thromboembolism Issue Published: 6 June 2000 CopyrightCopyright © 2000 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...