Why the study?
Does routine mechanical prophylaxis with selective chemoprophylaxis prevent fatal pulmonary embolism in patients undergoing primary hip and knee replacement?
Does routine mechanical prophylaxis with selective chemoprophylaxis prevent fatal pulmonary embolism in patients undergoing primary hip and knee replacement?
Routine mechanical prophylaxis combined with selective chemoprophylaxis for high-risk patients results in very low rates of fatal pulmonary embolism after joint replacement, suggesting routine chemical thromboprophylaxis may not be necessary.
Low fatal PE rates seen with mechanical plus selective chemoprophylaxis; leaves open whether routine chemoprophylaxis can be safely omitted.
In order to prevent fatal pulmonary embolism, TED stockings, foot pumps and early mobilisation on the second post-operative day are used at our centre. Only patients deemed to be high risk (previous DVT/PE or obese) are given clexane as inpatients and warfarin for six weeks postop. From the hospital database 1137 primary total hip replacements and 1017 primary total knee replacements were identified and the figures were confirmed with the theatre implant order books. The cause of death for those patients on the database, now deceased, was obtained from the coroner. Where a postmortem had not been performed the patient was assumed to have died of a PE. Within three months of surgery, a fatal PE rate of 0.09% (95% CI 0.00–0.26%) following hip replacement and 0.20% (95% CI 0.00–0.46%) after knee replacement was found. Thirty-four patients had been discharged on warfarin according to the pharmacy records. We would therefore not recommend the routine use of chemical thromboprophylaxis following joint replacement.
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Shepherd et al. (2006) studied this question.
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