Abstract
Introduction
Deep vein thrombosis(DVT) and pulmonary embolism(PE) are well-recognised complications following lower limb arthroplasty (Cohen et al, 2001). The National Institute for Clinical Excellence and British Orthopaedic Association recommend the use of both mechanical and chemical prophylaxis. At our institute regimens have changed reflecting new developments in the use of thombo-prophylaxis. Our aim was to assess the efficacy of these methods in preventing complications.
Methods
Since moving from Aspirin and compression stockings (TEDS) only, three different treatment methods were prospectively audited. Regimen 1 consisted of Aspirin (150 mg OD) and TEDS for 6 weeks (n=660). Regimen 2 used Clexane 40mg OD (n=448). Regimen 3 used Rivaroxaban (n=100) as licensed and Regimen 4 Dabigatran (n=185) as licensed.
We looked at rates of venous thromboembolism (VTE), rates of post op bleeding/haematoma and wound complications. Patients were reviewed prior to discharge, and at a six-week follow-up. Any casualty attendances were also recorded up to 12 weeks post-operatively.
Results
Symptomatic VTE rates were as follows 3.78% for Regimen 1, 1.9% for Regimen 2, 0% for Regimen 3 and 1.6% for regimen 4.
Haematoma/bleeding rates were as follows 1.06% Regimen 2, 5% Regimen 3, and 2.7% Regimen 4.
Rates of serosanguineous exudate were as follows 0.2% Regimen 2, 8% Regimen 3 and 5.4% Regimen 4.
Conclusion
Our move from Aspirin was based on local audit, which highlighted a higher than national average PE rate. A change towards oral based prophylaxis was based on ease of administration and potential reduction in costs. Although DVT/PE rates were lower with the oral thrombo-prophylaxis, bleeding and wound complications appear higher. This study highlights the need to monitor both VTE and bleeding rates when adopting any changes in protocol, with a view on individualised treatment on balance of risks.
