Key result
The incidence of venous thromboembolism was 21.7% in patients receiving no anticoagulants, compared to 9.0% with fondaparinux, 6.0% with enoxaparin, and 6.5% in patients selectively receiving no anticoagulants.
Why the study?
Does anticoagulant prophylaxis or selective no prophylaxis reduce the incidence of VTE compared to no anticoagulants in patients undergoing primary THA?
Cohort (n=319)
No
Does anticoagulant prophylaxis or selective no prophylaxis reduce the incidence of VTE compared to no anticoagulants in patients undergoing primary THA?
Anticoagulant prophylaxis and selective no prophylaxis based on patient factors both resulted in lower VTE incidence compared to no prophylaxis after total hip arthroplasty.
Answers are grounded in this paper and cite their sources.
Anticoagulant prophylaxis or selective omission was associated with lower VTE after THA; leaves open optimal strategies pending randomized trials.
Total hip arthroplasty (THA) is the most effective treatment for advanced or end-stage hip osteoarthritis. However, venous thromboembolism (VTE) remains one of its unresolved complications. We reviewed the records of 322 patients undergoing primary THA and investigated the efficacy of anticoagulant prophylaxis for VTE. Our study cohort consisted of 60 patients who received no anticoagulants, 100 patients who received a factor Xa inhibitor (fondaparinux), 100 patients who received low molecular weight heparin (enoxaparin), and 62 patients who selectively received no anticoagulant prophylaxis due to perioperative bleeding, weight, and/or hemoglobin concentration. Enhanced 64-slice multidetector row computed tomography was performed postoperatively for 7 days in all cases. The incidence of VTE in the four groups was 15%, 9.0%, 6.0%, and 6.4%, respectively. The incidence of VTE was significantly lower in the groups receiving anticoagulant prophylaxis and the group selectively receiving no anticoagulant prophylaxis than in the group receiving no anticoagulants. Complications of fondaparinux therapy included hepatic dysfunction in 4 cases (4.0%), minor bleeding in 2 cases (2.0%), persistent wound drainage in 3 cases (3.0%), and eruption in 1 case (1.0%). The complications of enoxaparin therapy were persistent wound drainage in 1 case (1.0%) and progression of anemia in 1 case (1.0%). The incidence of VTE was low in patients who selectively received no anticoagulant prophylaxis, so we conclude that anticoagulant prophylaxis should be used selectively in THA cases.
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Okada et al. (2015) conducted a cohort in Primary total hip arthroplasty (THA) (n=319). Anticoagulant prophylaxis (fondaparinux or enoxaparin) or selective omission vs. No anticoagulant prophylaxis was evaluated on Incidence of venous thromboembolism (VTE) at 7 days postoperatively. The incidence of venous thromboembolism was 21.7% in patients receiving no anticoagulants, compared to 9.0% with fondaparinux, 6.0% with enoxaparin, and 6.5% in patients selectively receiving no anticoagulants.
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