MULTIMODAL THROMBOPROPHYLAXIS IN PATIENTS WITH A PRIOR HISTORY OF VENOUS THROMBOEMBOLISM UNDERGOING PRIMARY HIP ARTHROPLASTY: SAFETY, EFFICACY AND ONE-YEAR-SURVIVAL

A. Gonzalez Della Valle; K. A. Shanaghan; E. A. Salvati

doi:10.1302/1358-992X.2019.12.039

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MULTIMODAL THROMBOPROPHYLAXIS IN PATIENTS WITH A PRIOR HISTORY OF VENOUS THROMBOEMBOLISM UNDERGOING PRIMARY HIP ARTHROPLASTY: SAFETY, EFFICACY AND ONE-YEAR-SURVIVAL

The Hip Society (THS) 2019 Summer Meeting, Kohler, WI, USA, 25–27 September 2019.

A. Gonzalez Della Valle
K. A. Shanaghan
E. A. Salvati

MULTIMODAL THROMBOPROPHYLAXIS IN PATIENTS WITH A PRIOR HISTORY OF VENOUS THROMBOEMBOLISM UNDERGOING PRIMARY HIP ARTHROPLASTY: SAFETY, EFFICACY AND ONE-YEAR-SURVIVAL

Valle AGD, Shanaghan KA, Salvati EA. MULTIMODAL THROMBOPROPHYLAXIS IN PATIENTS WITH A PRIOR HISTORY OF VENOUS THROMBOEMBOLISM UNDERGOING PRIMARY HIP ARTHROPLASTY: SAFETY, EFFICACY AND ONE-YEAR-SURVIVAL. Orthop Procs. 2019;101-B(SUPP_12):39-39. doi:10.1302/1358-992X.2019.12.039

Valle, A. Gonzalez Della, et al. “MULTIMODAL THROMBOPROPHYLAXIS IN PATIENTS WITH A PRIOR HISTORY OF VENOUS THROMBOEMBOLISM UNDERGOING PRIMARY HIP ARTHROPLASTY: SAFETY, EFFICACY AND ONE-YEAR-SURVIVAL.” Orthopaedic Proceedings, vol. 101-B, no. SUPP_12, 2019, pp. 39-39., https://doi.org/10.1302/1358-992X.2019.12.039

Valle, A. G. D., Shanaghan, K. A., & Salvati, E. A. (2019). MULTIMODAL THROMBOPROPHYLAXIS IN PATIENTS WITH A PRIOR HISTORY OF VENOUS THROMBOEMBOLISM UNDERGOING PRIMARY HIP ARTHROPLASTY: SAFETY, EFFICACY AND ONE-YEAR-SURVIVAL. Orthopaedic Proceedings, 101-B(SUPP_12), 39-39. https://doi.org/10.1302/1358-992X.2019.12.039

Valle, A. G. D., Shanaghan, K. A. and Salvati, E. A. (2019) “MULTIMODAL THROMBOPROPHYLAXIS IN PATIENTS WITH A PRIOR HISTORY OF VENOUS THROMBOEMBOLISM UNDERGOING PRIMARY HIP ARTHROPLASTY: SAFETY, EFFICACY AND ONE-YEAR-SURVIVAL.” Orthopaedic Proceedings, 101-B(SUPP_12), pp. 39-39. Available at: https://doi.org/10.1302/1358-992X.2019.12.039

Valle, A. Gonzalez Della, K. A. Shanaghan, and E. A. Salvati. “MULTIMODAL THROMBOPROPHYLAXIS IN PATIENTS WITH A PRIOR HISTORY OF VENOUS THROMBOEMBOLISM UNDERGOING PRIMARY HIP ARTHROPLASTY: SAFETY, EFFICACY AND ONE-YEAR-SURVIVAL.” Orthopaedic Proceedings 101-B, no. SUPP_12 (2019): 39-39. https://doi.org/10.1302/1358-992X.2019.12.039

Valle AGD, Shanaghan KA, Salvati EA. MULTIMODAL THROMBOPROPHYLAXIS IN PATIENTS WITH A PRIOR HISTORY OF VENOUS THROMBOEMBOLISM UNDERGOING PRIMARY HIP ARTHROPLASTY: SAFETY, EFFICACY AND ONE-YEAR-SURVIVAL. Orthop Procs. 2019 Oct 1;101-B(SUPP_12):39-39. https://doi.org/10.1302/1358-992X.2019.12.039

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Abstract

Introduction

We studied the safety and efficacy of multimodal thromboprophylaxis (MMP) in patients with a history of venous thromboembolism (VTE) undergoing total hip arthroplasty (THA). MMP includes discontinuation of procoagulant medications, VTE risk stratification, regional anesthesia, an intravenous bolus of unfractionated heparin before femoral work, rapid mobilization, the use of pneumatic compression devices, and chemoprophylaxis tailored to the patient's risk.

Material and methods

From 2004 to 2018, 257 patients (mean age: 67 years; range: 26–95) with a history of VTE underwent 277 primary, elective THAs procedures (128 right, 100 left, 9 single-stage bilateral, 20 staged bilateral) by two orthopaedic surgeons at a single institution. The patients had a history deep vein thrombosis (DVT) 186 (67%), pulmonary embolism (PE) 43 (15.5%), or both 48 (17.5%). Chemoprophylaxis included aspirin (38 patients) and anticoagulation (239 patients; Coumadin: 182, low-molecular-weight heparin: 3, clopidogrel: 1, rivaroxaban: 3, and a combination: 50). Forty eight patients (17.3%) had a vena cava filter at the time of surgery. Patients were followed for 120 days to detect complications, and for a year to detect mortality.

Results

Postoperative VTE was diagnosed in seven patients (2.5%): DVT in five, and PE with and without DVT in one patient each. Bleeding complications occurred in 2 patients, one requiring surgical evacuation of a hematoma. Seven patients died during the first year (2.5%). One patient died 5 months postoperatively of a fatal PE during open thrombectomy, and one patient died of a hemorrhagic stroke while receiving Coumadin. PE or bleeding was not suspected in any of the remaining 5 fatalities.

Conclusions

The result of this study spanning over 13 years, suggests that MMP is safe and effective. Postoperative anticoagulation should be prudent as very few patients developed postoperative VTE (2.5%) or died of suspected or confirmed PE. Mortality during the first year was mostly unrelated to VTE or bleeding.

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