低分子肝素联合间歇充气加压预防人工关节置换术后下肢深静脉血栓形成

目的比较在手术前后不同时间使用低分子肝素(low-molecular-weightheparin,LMWH)联合间歇充气加压装置(intermittentpneumaticcompression,IPC)预防人工关节置换术后下肢深静脉血栓(deepvenousthrombosis,DVT)形成的效果和安全性。方法2003年7月至2005年6月,156例人工关节置换手术病例,随机分成4组。第1组38例,术前使用LMWH、麻醉开始时即使用IPC;第2组42例,术后使用LMWH、麻醉开始时即使用IPC;第3组36例,术前使用LMWH、术后使用IPC;第4组40例,术后使用LMWH与IPC。进行DVT症状评估、下肢深静脉的彩超检查,观察出血并发症与记录围手术期出血量。结果第1组,DVT2例(5.26%),出血量(1030.8±282.0)ml;第2组,DVT2例(4.76%),出血量(900.7±246.9)ml;第3组,DVT1例(2.78%),出血量(1040.3±288.5)ml,1例上消化道出血;第4组,DVT9例(22.5%),出血量(852.2±295.4)ml。在DVT发生率上,第1、2、3组明显低于第4组(P﹤0.05);在围手术期出血量上,第2、4组少于第1、3组(P﹤0.05)。结论术后使用LMWH联合麻醉开始时即使用IPC以预防人工关节置换术后DVT发生的效果好,安全性高。     

下肢静脉泵预防髋部周围骨折深静脉血栓形成的临床研究

目的探讨针对有高出血风险患者,使用间歇充气加压装置（IPC）下肢静脉泵预防髋部周围骨折手术（HFS）后深静脉血栓形成（DVT）的临床疗效。方法 2008年7月至2011年7月,根据有高出血风险入选标准选择HFS患者32例,采用基本预防、下肢静脉泵物理预防。主要观察双下肢彩色多普勒超声检查结果和双下肢肿胀、疼痛等病症。结果对有高出血风险不能使用抗凝药物预防,采用IPC下肢静脉泵物理预防的32例HFS患者中有7例DVT,发生率21.88%,较本课题组之前未用物理预防与药物预防的对照组研究的发生率33.87%低。结论对于有高出血风险的HFS患者,选择IPC下肢静脉泵预防下肢DVT,能有效地降低DVT发生率,减少并发症,对于预防HFS术后DVT发生有临床意义。     

弹力绷带加压包扎联合低分子肝素预防老年人股骨转子间骨折术后深静脉血栓形成的疗效观察

目的探讨弹力绷带加压包扎联合低分子肝素(low molecular weight heparin, LMWH)预防老年人股骨转子间骨折术后下肢深静脉血栓形成(deep vein thrombosis, DVT)的疗效。方法回顾性分析西安交通大学医学院附属红会医院创伤骨科2016年3月至2018年1月收治的150例老年股骨转子间骨折病人的临床资料,所有病人手术前后均使用LMWH抗凝预防血栓形成,根据术后是否使用弹力绷带加压包扎分为观察组和对照组。观察组72例,其中男29例,女43例,年龄为(75.83±7.01)岁(65~87岁)。对照组78例,其中男30例,女48例,年龄为(74.77±7.55)岁(65~89岁)。病人骨折部位均采用闭合复位股骨近端防旋髓内钉治疗,术后第1、3、5天行双下肢静脉B超检查(观察组拆除弹力绷带后行双下肢静脉B超检查),记录并比较两组的DVT发生率及并发症情况。结果两组病人术后第1、3、5天的DVT发生率比较,差异均无统计学意义(P均>0.05);观察组共发生DVT 8例,发生率为11.11%,对照组19例发生DVT,发生率为24.36%,两组DVT总发生率比较,差异有统计学意义(χ^2=4.452,P=0.035);两组间术后下肢肿胀、皮下瘀斑、注射LMWH部位血肿发生率的差异均无统计学意义(P均>0.05)。结论弹力绷带加压包扎双下肢联合LMWH可降低老年股骨转子间骨折术后DVT发生率,简单、易行,值得临床推广。     

低分子肝素在老年股骨粗隆间骨折手术前后不同时间点应用的临床观察

目的比较在手术前后不同时间点使用低分子肝素(LMWH)预防老年股骨粗隆间骨折术后下肢深静脉血栓(DVT)形成的效果和安全性。方法自2010-01—2013-12对186例老年股骨粗隆间骨折行PFNA内固定治疗。根据病例入选标准,随机分成4组。a组术前48 h使用LMWH;b组术前24 h使用LMWH;c组术前12 h使用LMWH;d组术后12 h使用LMWH。术后进行DVT症状评估、下肢深静脉的彩超检查,观察出血并发症与记录围手术期出血量。结果a组发生DVT 1例(2%),出血量(352.6±63.0)ml;b组发生DVT 5例(10.4%),出血量(328.6±72.6)ml;c组发生DVT 5例(11.9%),出血量(328.6±67.3)ml;d组发生DVT 16例(34.8%),出血量(292.5±62.8)ml。在DVT发生率上,a组明显低于b、c、d组(P0.05);在围手术期出血量上,a组多于b、c、d组。结论术前48 h使用LMWH预防老年股骨粗隆间骨折术后发生DVT的效果好,不会增加出血性事件发生率,安全性高。     

低分子肝素预防髋、膝关节手术后下肢深静脉血栓形成的多中心研究

目的 探讨国人髋、膝关节手术后下肢深静脉血栓（deepvenous thrombosis,DVT）的发生率及应用低分子肝素预防DVT的有效性和安全性。方法 根据入选标准选择120例髋、膝关节手术患者,分别在北京、上海、广州三个中心参加该项研究,观察组和对照组分别为68例和52例。观察组中男30例,其中全髋关节置换术19例,全膝关节置换术2例,动力髋螺钉（DHS）9例;女38例,其中全髋关节置换术17例,全膝关节置换术17例,DHS4例。对照组中男21例,其中全髋关节置换术19例,全膝关节置换术1例,DHS1例;女31例,其中全髋关节置换术15例,全膝关节置换术15例,DHS1例。结果 除观察组与对照组女性全髋关节置换术患者术中、术后失血量差异有统计学意义（P〈0．05）外,其余出血量差异均无统计学意义（P〉0．05）。手术前后血红蛋白、血小板、凝血酶原时间及活动度与活化部分凝血活酶时间变化差异均无统计学意义（P〉0．05）。两组患者术后下肢DVT发生率差异有统计学意义（P〈0．05）。观察组总的不良反应发生率为8．8％（6.68）。结论 低分子肝素可以有效预防髋、膝关节置换术后DVT的发生,同时对于已发生的DVT有良好的治疗效果,不良反应发生率低。     

老年髋关节周围骨折围手术期应用低分子肝素预防下肢深静脉血栓的研究

目的探讨应用低分子肝素围手术期预防髋关节周围骨折下肢深静脉血栓(DVT)发生的有效性和安全性。方法选取髋关节周围骨折患者70例,随机分为两组,对照组行物理方法预防;实验组行物理方法加低分子肝素预防。比较两组DVT和并发症发生率。结果对照组术前7例DVT形成,发生率为18.42%,试验组发生率为0%,差异有统计学意义(P0.05);对照组31例中术后8例DVT形成,实验组32例中术后2例发生DVT;差异有统计学意义(P0.05)。无一例发生出血。结论应用低分子肝素能有效预防髋部骨折患者围手术期DVT的发生。     

基于Caprini风险评估的股骨转子间骨折围手术期抗凝策略的探讨

目的 以Caprini风险评分系统对股骨转子间骨折患者围手术期进行风险评估,探讨股骨转子间骨折围手术期的抗凝策略. 方法对2005年1月至2010年1月间采用切开复位内固定术或人工股骨头置换术治疗的268例股骨转子间骨折患者进行回顾性分析.以Caprini风险评分系统评分进行分组:高危组和极高危组,记录每组中分别于术前12 h开始及术后12 h开始使用低相对分子质量肝素(LMWH)的患者术中出血量、48 h切口引流量、术后血红蛋白降低值及术后双下肢DVT的发生情况,并进行比较分析. 结果①Caprini评分高危组中,与术前12 h开始使用LMWH比较,术后12 h开始使用患者术后DVT发生率相近,差异无统计学意义(P＞0.05);但术中出血、术后48 h引流量及术后血红蛋白降低值明显减少,差异有统计学意义(P＜0.05).②Caprini评分极高危组中,与术前12 h开始使用LMWH比较,术后12 h开始使用患者术后DVT发生率升高,术中出血量减少,差异均有统计学意义(P＜0.05);但术后48 h引流量及术后血红蛋白降低值差异无统计学意义(P＞0.05). 结论股骨转子间骨折Caprini评分高危患者围手术期抗凝可采用术后12 h开始皮下注射LMWH,而Caprini评分极高危患者可予术前12 h开始皮下注射LMWH.术前可以参考Caprini风险评估来决定围手术期抗凝方案的选择.     

低分子肝素预防人工髋关节置换术后下肢深静脉血栓形成

目的 对比观察采用低分子肝素(LMWH)预防人工髋关节置换(THR)术后下肢深静脉血栓形成(DVT)的临床效果.方法 将行人工髋关节置换术的132例患者随机分为未用药组和用药组,其中未用药组36例,未预防性使用任何药物;用药组96例,围手术期给予LMWH预防性治疗.术前及术后第7～14天,两组患者均行患肢彩色多谱勒超声检查,评价DVT形成情况及两组术后DVT发生率.结果 未用药组中有8例DVT阳性,DVT的发生率22.2%,用药组中有9例DVT阳性,发生率9.3%;两组比较,差异有统计学意义(P＜0.05).用药组未发现术中、术后出血增多以及药物不良反应.结论 LMWH可显著降低围手术期THR术后DVT的发生,且具有良好的安全性.     

术前应用低分子肝素对非体外循环冠状动脉旁路移植术后早期疗效的影响

摘要：目的探讨术前应用低分子肝素（10wmolecularweightheparin,LMWH）对行非体外循环冠状动脉旁路移植术（off-pumpcoronaryarterybypassgrafting,OPCAB）患者术后早期疗效的影响。方法回顾性分析2011年4月1日至2012年9月30日中国医科大学附属第一医院809例行单纯OPCAB患者的临床资料,根据术前是否应用LMWH分为两组,LMWH组：386例,男290例,女96例;年龄49～81岁;术前停用抗血小板药物后均常规给予低分子肝素（低分子肝素钠或低分子肝素钙,4000U每日2次,皮下注射）抗凝治疗,直至手术前一天早晨。对照组：423例,男321例,女102例;年龄46～78岁;直接停用抗血小板药物,而不应用LMWH或其它抗凝药物。比较两组患者的死亡率、围术期心肌梗死发生率、手术时间、失血量、输血量、术后急性肾功能不全发生率等。结果LMWH组患者术中失血量[（296±94）mlVS．（249±81）ml,P=0．03]、术后胸腔引流量[（526_＋159）mlVS．（410±125）ml,P=0．02]、输红细胞量[（2．6±1．1）UVS．（1．4±0．9）U,P=-0．04]以及手术时间[（172±34）minVS．（154_＋41）min．P=0．04]均显著大于对照组,而两组间手术死亡率（1．0％VS．1．2％,P=I．00）、围术期心肌梗死发生率（4．4％VS．3．8％,P=0．55）差异无统计学意义。结论对于稳定的缺血性心脏病,术前不用LMWH可缩短手术时间、减少失血量和输血量,并不增加手术死亡率以及围术期心肌梗死的发生率。     

超早期间歇充气加压预防老年转子间骨折术后下肢深静脉血栓形成的病例对照研究

目的:评价超早期间歇充气加压(intermittent pneumatic compression,IPC)治疗预防老年股骨转子间骨折术后下肢深静脉血栓形成的疗效。方法:对2008年5月至2010年5月收治的80例老年股骨转子间骨折患者分为超早期组和术后组,各40例,其中超早期组男21例,女19例,年龄67～86岁,平均(76.4±13.27)岁;术后组男26例,女14例,年龄68～89岁,平均(75.8±12.71)岁。超早期组为术前3d开始使用IPC,术后组术后当天开始使用IPC。分别测定患者术前第3天,术后第3、7、14天血清D-二聚体(D-D)浓度。术前第3天,术后第3、14天通过双下肢深静脉超声检查患者DVT发生情况。记录两组患者的围手术期出血量。结果:两组患者术前第3天血清D-D浓度及双下肢DVT发生情况差异无统计学意义,两组患者围手术期出血量差异无统计学意义。超早期组术后第3、7天血清D-D浓度分别为(351.00±104.34)、(412.31±106.95)μg/ml,比术后组(419.34±145.38)、(509.16±146.05)μg/ml低;术后第14天,两组患者血清D-D浓度差异无统计学意义。两组患者术后第3天DVT发生率分别为7.5%、12.5%,差异无统计学意义;术后第14天术后组DVT发生率为22.5%,高于超早期组。结论:与术后开始使用IPC相比,超早期使用IPC在不增加老年转子间骨折围手术期出血量的情况下可降低患者术后血清D-D浓度水平,并能降低DVT的发生率。     

Deep vein thrombosis after total hip arthroplasty in Indian patients with and without enoxaparin

PURPOSE: To study the incidence of deep vein thrombosis in Indian patients undergoing total hip arthroplasty with or without prophylaxis, and the effect of enoxaparin on deep vein thrombosis. METHODS: The study covered a total of 50 hips in 40 patients who underwent total hip arthroplasty. Patients were assessed for deep vein thrombosis using Doppler ultrasonography. The hips were numbered and divided into 2 groups: the odd-numbered hips did not receive any thrombo-prophylaxis, whereas the even-numbered hips received 40 mg of enoxaparin subcutaneously, once a day for 2 weeks, until the time of discharge. RESULTS: Deep vein thrombosis was not found in both groups. We found wound haematomas in 9 patients (all of whom were on enoxaparin) (p<0.05), superficial infection in 2 patients (one on enoxaparin, one not), and local bruising in 4 patients (all of whom were on enoxaparin). Major haemorrhage did not occur in any of the cases. CONCLUSION: The incidence of deep vein thrombosis in Indian patients is very low compared to that in European and American patients. Enoxaparin failed to provide any advantage to the patients. It is therefore not advisable to give prophylaxis/low-molecular-weight heparin for deep vein thrombosis to patients undergoing total hip arthroplasty without any risk factors.     

Late deep venous thrombosis and delayed weightbearing after total hip arthroplasty

One hundred ninety-nine patients who underwent primary total hip arthroplasty and used in hospital pneumatic compression stockings and aspirin as thromboembolic prophylaxis were screened for deep venous thrombosis using duplex ultrasonography on the fourth postoperative day. Of the initial 98 patients, 21 underwent noncemented arthroplasty, maintained touchdown weightbearing for 6 weeks after surgery, and then began progressive partial weightbearing. Of the subsequent 101 patients, 28 underwent noncemented arthroplasty and began progressive weightbearing immediately after surgery. All other patients underwent hybrid arthroplasty and began weightbearing to tolerance immediately after surgery. After duplex screening examination, patients with proximal deep venous thrombosis were given anticoagulation therapy, and patients with negative study results were observed clinically. The relative risk of proximal deep venous thrombosis after noncemented arthroplasty using delayed weightbearing was compared with that after noncemented arthroplasty using immediate progressive weightbearing. Of patients with noncemented arthroplasty, the prevalence of proximal deep venous thrombosis was significantly lower in those using progressive weightbearing immediately after surgery (none) than in those using delayed weightbearing rehabilitation (19%). This study showed that patients undergoing noncemented total hip arthroplasty with delayed weightbearing rehabilitation risk greater potential for deep venous thrombosis after hospital discharge. This study suggests consideration for continued thromboembolic prophylaxis or routine deep venous thrombosis surveillance, or both measures, after hospital discharge, unless more rapid progression of weightbearing is allowed.     

高龄髋关节置换术后深静脉血栓形成的防治

目的探讨高龄患者行人工髋关节置换术后深静脉血栓形成的防治。方法21例高龄患者行髋关节置换术,术后深静脉血栓形成时立即进行超声多普勒检查。结果术后死亡1例,20例中出现深静脉近端血栓6例,远端血栓14例,无全静脉血栓。经卧床休息、抬高患肢、使用弹力袜,抗凝溶栓治疗好转。结论高龄患者多伴有心血管或呼吸系统疾病,围手术期的正确处理和规范细致的手术操作可以减少和治疗髋关节置换术后深静脉血栓的形成。     

Venous thromboembolic disease after hybrid hip arthroplasty with negative duplex screening

Postoperative duplex ultrasonography screening after total hip arthroplasty has been shown to identify patients who may require treatment or additional monitoring for venous thromboembolic disease. The potential for manifestation of venous thromboembolic disease subsequent to screening remains a concern. The objective of this study was to determine the prevalence of symptomatic venous thromboembolic disease after total hip arthroplasty and after inhospital prophylaxis, inhospital screening with negative results for proximal deep venous thrombosis, and no posthospitalization venous thromboembolic disease prophylaxis. One hundred fifty patients undergoing primary hybrid total hip arthroplasty and using pneumatic compression stockings and aspirin as prophylaxis against venous thromboembolic disease were screened for deep venous thrombosis with duplex ultrasonography on the fourth day after surgery. Duplex ultrasonography screening revealed 17 (11.3%) patients with asymptomatic proximal deep venous thrombosis. In response to duplex ultrasonography screening, these patients with proximal deep venous thrombosis received therapeutic anticoagulation. Of 133 patients with a duplex screen with negative results for proximal deep venous thrombosis, 131 (98.5%) continued to have no symptoms of venous thromboembolic disease and two (1.5%) began to have symptoms for venous thromboembolic disease (one with proximal deep venous thrombosis, one with nonfatal pulmonary embolism) during 12 months of clinical followup after total hip arthroplasty. The overall prevalence of venous thromboembolic disease requiring anticoagulation was 19 of 150 (12.6%) patients. The remaining 131 (87.4%) were not exposed to the risks of postoperative anticoagulation and did not have subsequent symptomatic venous thromboembolic disease.     

Proximal deep vein thrombosis after hip replacement for oncologic indications

BACKGROUND: Patients with cancer who undergo surgery about the hip are at increased risk for the development of deep vein thrombosis. We implemented a program of chemical and mechanical prophylaxis to prevent this problem. This study was performed to assess the effectiveness of that program. METHODS: Eighty-seven consecutive patients with an active malignant tumor who underwent hip replacement surgery at our institution over a two-year period were included in the study. All patients were treated with intermittent pneumatic compression devices. Seventy-eight patients received anticoagulants, and nine did not. Postoperative surveillance for proximal deep vein thrombosis was routinely performed on all patients with duplex Doppler ultrasonography. RESULTS: Four patients had proximal deep vein thrombosis, and one patient, who did not receive anticoagulation, had a nonfatal pulmonary embolism. The use of prophylactic low-molecular-weight heparin (dalteparin) was associated with a 4% rate of proximal deep vein thrombosis (three of seventy-eight patients). Proximal deep vein thrombosis developed in three of eight patients with pelvic disease, one of nineteen patients with femoral disease, and zero of sixty patients with hip disease (p < 0.00001). The prevalence of proximal deep vein thrombosis was significantly higher (p < 0.02) following replacements in patients with sarcoma (three of twenty-one) than it was after replacements in patients with carcinoma (zero of fifty-seven) or hematologic malignant disease (one of nine). On multivariate analysis, only the location of the disease (the pelvis, femur, or hip) was found to be independently significant for an association with deep vein thrombosis. A wound complication developed in four of twenty-one patients with sarcoma and no patient with carcinoma or hematologic malignant disease (p < 0.001). The pathologic type was the only factor studied that was independently significant for an association with wound complications on multivariate analysis. CONCLUSIONS: The rate of proximal deep vein thrombosis in patients who had undergone hip replacement for oncologic indications was low when the use of an intermittent pneumatic compression device was supplemented with prophylaxis with low-molecular-weight heparin.     

Deep venous thrombosis after total hip or total knee arthroplasty in patients in Japan

A single center, prospective, epidemiologic study was conducted to estimate the incidence of deep venous thrombosis detected by venography in patients in Japan undergoing total hip arthroplasty or total knee arthroplasty without prophylactic anticoagulant therapy. Venograms of 164 patients who had total hip arthroplasty and 138 patients who had total knee arthroplasty were evaluated. The incidences of deep venous thrombosis were 22.6% in patients who had total hip arthroplasty and 48.6% in those who had total knee arthroplasty. The incidences of proximal deep venous thrombosis were 9.8% in patients who had total hip arthroplasty and 14.5% in those who had total knee arthroplasty. Statistical analysis revealed that the type of operation influenced the development of deep venous thrombosis. Patients who had total knee arthroplasty were 3.2 times more likely to have deep venous thrombosis develop than were patients who had total hip arthroplasty. Body mass index and age were identified as statistically significant risk factors.     

Effect of mechanical compression on the prevalence of proximal deep venous thrombosis as assessed by magnetic resonance venography

BACKGROUND: Patients have been shown to be at greater risk for deep venous thrombosis, particularly proximal thrombosis, after total hip arthroplasty. Proximal thrombi are more likely to develop into pulmonary emboli than are distal thrombi. The purpose of this randomized, prospective study was to compare the prevalence of pelvic and proximal lower-extremity deep venous thrombosis after primary total hip arthroplasty between patients treated with an impulse mechanical compression device for prophylaxis and those treated with prophylactic stockings. METHODS: One hundred patients were evaluated, with use of magnetic resonance venography, for proximal deep venous thrombosis after total hip arthroplasty. Fifty patients were treated with a mechanical compression device on both lower extremities, and the other fifty patients received only prophylactic stockings. Both groups of patients received hypotensive epidural anesthesia and 325 mg of aspirin twice a day. RESULTS: Overall, proximal deep venous thrombi were found in 15% of the 100 patients. Of the fifty patients treated with mechanical compression, 8% (four) had a positive venogram. Of the fifty control patients, 22% (eleven) had a positive venogram (p < 0.05). However, overall the rate of occlusive thrombi was 6% (six) compared with an overall rate of nonocclusive thrombi of 9% (nine). The rate of occlusive thrombi was 2% (one of fifty) in the study group and 10% (five of fifty) in the control group (p = 0.04). CONCLUSIONS: On the basis of this study, we concluded that patients managed with total hip arthroplasty benefit from a reduction in the rates of femoral and pelvic deep vein thrombosis when they are treated with hypotensive epidural anesthesia, mechanical compression, and aspirin and are subsequently assessed with magnetic resonance venography.     

应用下腔静脉滤网治疗髋关节置换术前合并深静脉血栓的效果

目的探讨下腔静脉滤网在髋关节骨折伴有下肢深静脉急性血栓形成患者中的应用价值。 方法回顾性收集2010年3月至2012年3月新疆维吾尔自治区人民医院收治的髋关节骨折合并下肢深静脉血栓患者15例,男性8例,女性7例,年龄65~82岁,平均年龄（73±5）岁。术前置入下腔静脉滤网后再行髋关节置换术,术后随访评价患者静脉血栓、Harris评分、影像学改善等情况。 结果所有患者均获得满意随访,随访时间1~12个月。15例患者均顺利完成手术,无一例发生肺栓塞及其他严重并发症。所有髋关节骨折患者均实现了骨性愈合,股骨柄稳定,均未见松动。血常规、血沉及C反应蛋白均未见感染征象。Harris评分由术前的（16±12）分提高至末次随访的（86±6）分,差异有统计学意义（t=-36.594,P<0.001）。所有患者均未见滤器周围血栓形成及相关并发症。其中10例血栓消失,5例血栓缩小,术后患者功能恢复满意。 结论术前下腔静脉滤网植入应用于伴有下肢深静脉急性血栓的髋关节置换术,可提高手术的安全性,帮助患者早日下床活动,提高患者生活质量。     

Frequency and timing of clinical venous thromboembolism after major joint surgery

Over a 13-year period we studied all patients who underwent major hip and knee surgery and were diagnosed with objectively confirmed symptomatic venous thromboembolism, either deep venous thrombosis or non-fatal pulmonary embolism, within six months after surgery. Low-molecular-weight heparin had been given while the patients were in hospital. There were 5607 patients. The cumulative incidence of symptomatic venous thromboembolism was 2.7% (150 of 5607), of which 1.1% had developed pulmonary embolism, 1.5% had deep venous thrombosis and 0.6% had both. Patients presented with deep venous thrombosis at a median of 24 days and pulmonary embolism at 17 days after surgery for hip fracture. After total hip replacement, deep venous thrombosis and pulmonary embolism occurred at a median of 21 and 34 days respectively. After total knee replacement, the median time to the presentation of deep venous thrombosis and pulmonary embolism was 20 and 12 days respectively. The cumulative risk of venous thromboembolism lasted for up to three months after hip surgery and for one month after total knee replacement. Venous thromboembolism was diagnosed after discharge from hospital in 70% of patients who developed this complication. Despite hospital-based thromboprophylaxis, most cases of clinical venous thromboembolism occur after discharge and at different times according to the operation performed.     

Thromboembolic disease prophylaxis in patients with hip fracture: a multimodal approach

OBJECTIVES: To assess if pneumatic compression in conjunction with chemoprophylaxis is an effective way to reduce the incidence of deep vein thrombosis in orthopedic trauma patients sustaining fragility hip fractures. DESIGN: Two hundred patients admitted to the authors' institution between May 1998 and June 2002 for fractures of the hip were prospectively studied. All patients were treated operatively and received the VenaFlow calf compression device on both lower extremities immediately following surgery. Chemical prophylaxis of either aspirin (n = 67) or warfarin (n = 133) was administered in addition to mechanical compression. A noninvasive serial color flow duplex scan was performed 1 to 11 days postoperatively (mean 4.5 days) to determine the presence or absence of deep vein thrombosis. All patients were followed clinically 3 months postoperatively for a clinical evaluation of symptomatic deep vein thrombosis or pulmonary embolism. RESULTS: Overall, the incidence of deep vein thrombosis was 3.5% (7 of 200) and included only 1 proximal thrombosis (1 out of 200, or 0.5%) and no pulmonary embolism. Five of the 7 patients positive for deep vein thrombosis were in the mechanical compression and warfarin prophylaxis group and 2 were in the aspirin arm of the study. For patients with deep vein thrombosis, the average number of risk factors was 3.71, whereas patients without clots averaged 1.75 clinical risk factors (P < or = 0.05). Three patients in the warfarin group developed bleeding complications (1 with a gastrointestinal bleed and 2 with minor bleeding not at the operative site). No evidence of a symptomatic deep vein thrombosis or pulmonary embolism was reported within a 3-month period following hospitalization. CONCLUSIONS: Our findings suggest mechanical compression with the VenaFlow calf compression device in conjunction with chemoprophylaxis is an effective means of reducing thromboembolic disease in this high-risk population.