In-hospital thromboprophylaxis alone found to be safe with fast-track THA, TKA
The rate of thromboembolic events was 0.84% among about 4,500 patients who underwent fast-track unilateral total hip arthroplasty or total knee arthroplasty who had a median hospital stay of 2 days and only received thromboprophylaxis during that time, according to research by investigators from Denmark.
They found a 0.41% rate of venous thromboembolic events (VTEs) at the same follow-up in their prospective multicenter cohort study, leading them to conclude it is safe to limit administration of thromboprophylaxis to the hospital stay alone in patients who undergo fast-track total hip arthroplasty (THA) or total knee arthroplasty (TKA).
First author of the study, Christoffer C. Jørgensen, MD, told Orthopaedics Today Europe that what is most groundbreaking about these findings is that “about 95% of almost 5,000 patients with thromboprophylaxis for a median of 2 days had VTEs comparable to or lower than in previous studies with prophylaxis of 30 days to 35 days.”
The study included 4,924 consecutive unselected unilateral THAs and TKAs performed in 4,718 patients at six Danish clinics. None of the patients were given continuous “potent” anticoagulative therapy preoperatively, and during their hospital stays of 5 days or less, the VTE prophylaxis they were administered consisted of either low-molecular weight heparin or factor Xa-inhibitors.
Jørgensen told Orthopaedics Today Europe that the investigators all used a similar fast-track protocol for the study. “There were minor differences with regard to the protocols used at the participating departments, mainly considering the use of NSAIDs/COX-2 inhibitors and also regarding the use of postoperative restrictions in THA,” he said.
“Early mobilization seems to be the most critical factor for fewer thromboembolic events after total joint arthroplasty," Jørgensen said.
Of the documented VTEs, five were pulmonary embolisms (0.11%), one of which was fatal, and 14 were deep venous thrombosis (0.30%).
Given these findings, which support discontinuing thromboprophylaxis after discharge from hospital in this patient population, the researchers wrote that “guidelines on postoperative thromboprophylaxis need reconsideration in modern elective surgical procedures.” — by Christian Ingram
Reference:
Given these findings, which support discontinuing thromboprophylaxis after discharge from hospital in this patient population, the researchers wrote that “guidelines on postoperative thromboprophylaxis need reconsideration in modern elective surgical procedures.” — by Christian Ingram
Reference:
Disclosure: Two of the study’s co-authorsare board members of the Health Care initiatives, Biomet Rapid Recovery.
No hay comentarios:
Publicar un comentario