Thromboprophylaxis after Hip Replacement Surgery

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Presentation transcript:

Thromboprophylaxis after Hip Replacement Surgery Amit Bishnoi Haroon Majeed Girish Swamy Tarek Abuzakuk (Royal Derby Hospital)

Background Several agents; no clear preference NICE recommends: LMWH or Fondaparinux for 4 weeks post-op BOA: Still debating Newer drugs: Rivaroxaban and dabigatran.

Aim To define the efficacy and safety of various chemical agents; - Aspirin - Warfarin - LMWH To agree a common protocol.

Patients and methods Retrospective review Primary Hip Arthroplasty Over 18 month period Data base to include: - Demographics - IP and OP thromboprophylaxis - Complications - Mortality

Results: 905 hip arthroplasty 574 females 476 on left side 1 bilateral Mean age 67.6 (range:14-95)

Type of Replacement

Thromboprophylaxis

Complications 18% (n=162) had blood transfusion 43 investigated for proximal DVT 18 confirmed DVT One fat embolism Two PE. Mortality of 0.4% (n=4)

Blood transfusion requirements Percentage (of total) Aspirin = 13.8% Warfarin = 23% Enoxaparin=22%

Thromboprophylaxis in Pts with proximal DVT

Average Hospital Stay Post op: Aspirin 5.1 days Warfarin 5.2 days Enoxaparin 6.4 days Other 11 days

Literature Review Wylde et al: J Bone Joint Surg Br. 2008 Mar;90(3):306-7 Retrospective study ( n=1549) Elective primary hip arthroplasty 90 day mortality in patients using Aspirin as thromboprophylaxis

Freedman et al. A meta-analysis of thromboembolic prophylaxis following elective total hip arthroplasty. J Bone Joint Surg [Am] 2002;82-A:929–38. 52 RCT from 1966 to 1998 Compared LMWH, Low dose Heparin, Aspirin(150-900mg BD), Warfarin and pneumatic compression Warfarin most effective against DVT No difference in fatal PE Increased risk of bleeding with heparin

Daniel et al. Multimodal thromboprophylaxis following primary total hip replacement. J Bone Joint Surg(Br) 2008;90-B:562-9. Retrospective study Comparison between 2 groups- with and without pneumatic compression. Both groups had asymptomatic DVT detected ultrasonographically.

Conclusion Aspirin appears to be a effective thromoprophylactic agent Limitations: Retrospective Unable to compare pneumatic compression Type of anaesthesia, operating time, early mobility not taken into account.