DOI: https://doi.org/10.15674/0030-59872017172-79

Is there not a better way to prevent venousthromboembolism after total knee arthroplasty?

Mark A. Snyder, Oleg Vyrva

Abstract


Background: aspirin at 325 mg twice daily is now included as a nationally approved venous thromboembolism prophy­laxis protocol for low risk total knee arthroplasty patients.

The purpose of this study is to examine if there is a difference in deep vein thrombosis occurrence after a limited tourni­quet total knee arthroplasty using aspirin-based prophylaxis with or without extended use of mechanical compression device therapy.

Methods: one hundred limited tourniquet total knee ar­throplasty patients, whose deep vein thrombosis risk was managed with aspirin 325 mg twice daily for 3 weeks, were ran­domized to either utilizing an mechanical compression device during hospitalization only or extended use at home up to six weeks post-op. Lower extremity Duplex venous ultrasonogra­phy was completed on the second post-op day, 14 days post-op, and at 3 months post-op to confirm absence of deep vein thrombosis after treatment.

Results: the deep vein thrombosis rate for the post-discharge mechanical compression device therapy group was 0 % and 23.1 % for the inpatient mechani­cal compression device group (p < 0.001). All deep vein throm­bosis resolved by 3 months postop. Patient satisfaction was 9.56 ± 0.82 for post-discharge mechanical compression device patients versus 8.50 ± 1.46 for in patient mechanical compres­sion device patients (p < 0.001).

Conclusion: limited tourniquet total knee arthroplasty patients that were mobilized early, managed with Aspirin for 3 weeks post-op, and mechanical com­pression device therapy for up to 6 weeks post-op experienced superior deep vein thrombosis prophylaxis than patients receiv­ing mechanical compression device therapy only as an inpatient (p < 0.05). The 0 % incidence of non-symptomatic deep vein thrombosis prevented by Aspirin and extended use mechanical compression device further validates this type of prophylaxis in low deep vein thrombosis risk total knee arthroplasty pa­tients.

Keywords


total knee arthroplasty; aspirin; mechanical compression mobilization

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