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

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

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

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

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

6. Type of Replacement

7. Thromboprophylaxis

8. 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)

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

10. Thromboprophylaxis in Pts with proximal DVT

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

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

13. 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( mg BD), Warfarin and pneumatic compression
Warfarin most effective against DVT
No difference in fatal PE
Increased risk of bleeding with heparin

14. 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.

15. 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.