Why the study?
Does fixed mini-dose warfarin compared to adjusted-dose warfarin prevent venous thrombosis in patients undergoing total hip arthroplasty?
Does fixed mini-dose warfarin compared to adjusted-dose warfarin prevent venous thrombosis in patients undergoing total hip arthroplasty?
Adjusted-dose warfarin (INR 2.0-4.0) is more effective than fixed mini-dose warfarin (1 mg daily) for preventing venous thrombosis after total hip arthroplasty, though it is associated with more bleeding complications.
Adjusted-dose warfarin preferred for post-THA VTE prophylaxis; confirms therapeutic INR superiority over fixed mini-dose in RCT.
Venous thrombosis rates were compared in 200 patients undergoing total hip arthroplasty and randomized to receive either fixed mini-dose warfarin (1 mg daily) or adjusted-dose warfarin to maintain an international normalized prothrombin ratio (INR) of 2.0-4.0. Bilateral lower limb venography was performed between days 11 and 13 inclusive. Fixed mini-dose warfarin was associated with a significantly higher rate of total thrombosis (P less than 0.05). General anaesthesia was associated with a significantly higher rate of thrombosis than spinal anaesthesia (P less than 0.05). Adjusted-dose warfarin was associated with more bleeding complications than mini-dose warfarin although these were not attributable to excessive anticoagulation. A single death from pulmonary embolus occurred in the early postoperative period in a patient receiving adjusted-dose warfarin.
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Feller et al. (1992) studied this question.
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