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Thromb Haemost 2018; 118(12): 2152-2161
DOI: 10.1055/s-0038-1675641
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Safety of In-Hospital Only Thromboprophylaxis after Fast-Track Total Hip and Knee Arthroplasty: A Prospective Follow-Up Study in 17,582 Procedures

Pelle Baggesgaard Petersen
1   Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark
,
Henrik Kehlet
1   Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark
2   Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark
,
Christoffer Calov Jørgensen
1   Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark
2   Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark
,
on behalf of the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group › Author Affiliations
Further Information

Publication History

02 August 2018

06 October 2018

Publication Date:
19 November 2018 (online)

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Abstract

Most international guidelines recommend pharmacological thromboprophylaxis after total hip and knee arthroplasty (THA/TKA) for 10 to 35 days. However, a recent cohort study on fast-track THA and TKA questioned the need for prolonged thromboprophylaxis when length of stay (LOS) is ≤ 5 days. We aimed at re-investigating the incidence of venous thromboembolism (VTE) in fast-track THA and TKA with in-hospital only thromboprophylaxis when LOS was ≤ 5 days. Prospective cohort study from 1 December 2011 to 30 October 2015 on elective unilateral THA/TKA with in-hospital only thromboprophylaxis if LOS was ≤ 5 days. Prospective information on co-morbidity and complete 90-day follow-up through the Danish National Patient Registry and medical records. Patients with pre-operative use of anticoagulants were excluded. In per protocol analysis, 17,582 (95.5%) had LOS of ≤ 5 days (median, 2 [interquartile range, 2–3]) and in-hospital thromboprophylaxis only. Incidence of symptomatic VTE was 0.40%, consisting of 28 (0.16%) pulmonary embolisms (PEs), 38 (0.22%) deep vein thrombosis (DVT) and 4 (0.02%) combined DVT and PE. Two PEs (0.01%) were fatal. VTE-associated risk factors with in-hospital only thromboprophylaxis were age > 85 years, odds ratio (OR) of 3.74 (95% confidence interval: 1.15–12.14, p = 0.028), body mass index (BMI) of 35 to 40, OR of 2.55 (1.02–6.35, p = 0.045) and BMI > 40, OR of 3.28 (1.02–10.56, p = 0.046). In conclusion, 90-day incidence of VTE after fast-track THA and TKA with in-hospital thromboprophylaxis only was 0.40%. Prolonged thromboprophylaxis may be reserved for LOS > 5 days or specific high-risk patients, but requires further studies regarding optimal type and duration of thromboprophylaxis.

Keywords

fast-track - enhanced recovery - arthroplasty - thromboprophylaxis - venous thromboembolism

* Members of the Lundbeck Foundation Centre for Fast-track Hip and Knee Collaborative Group: Frank Madsen, MD, Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark; Torben B. Hansen, Prof., MD, PhD, Department of Orthopedics, Regional Hospital Holstebro and University of Aarhus, Holstebro, Denmark; Henrik Husted, MD, DMSci, Department of Orthopedics, Hvidovre Hospital; Hvidovre, Denmark. Mogens B. Laursen, Ass. Prof., MD, PhD, Aalborg University Hospital Northern Orthopaedic Division, Aalborg, Denmark; Lars T. Hansen, MD, Department of Orthopedics, Sydvestjysk Hospital Esbjerg/Grindsted, Grindsted, Denmark; Per Kjærsgaard-Andersen, Ass. Prof., MD, Department of Orthopedics, Vejle Hospital, Vejle, Denmark; Soren Solgaard, MD, DMSci, Department of Orthopedics, Gentofte University Hospital, Copenhagen, Denmark; Niels Harry Krarup, MD, Department of Orthopedics, Viborg Hospital, Viborg, Denmark.


 

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