A Comparison of Discharge and Two-Week Duplex Ultrasound Screening Protocols for Deep Venous Thrombosis Detection Following Primary Total Joint Arthroplasty

Abstract

There was no significant difference between the group that received two weeks of warfarin chemoprophylactic prophylaxis and the group that was screened at the time of hospital discharge with regard to the detection of deep venous thrombosis with use of compression ultrasound. On the basis of these findings, we no longer screen asymptomatic patients for deep venous thrombosis following hip and knee replacement, and all patients receive warfarin anticoagulation for two weeks.

Screening for deep venous thrombosis after idiopathic scoliosis surgery in children: a pilot study

“…Concern about the potential risk for pulmonary embolism as a result of asymptomatic deep venous thrombosis has led clinicians to consider performing routine screening tests to diagnose asymptomatic venous thrombosis especially in high‐risk adult patients (15,16). But, surveillance scanning did not enable reliable prediction of pulmonary embolism in adult orthopedic surgery (17).…”

Does Aspirin Like Enoxaparin Effective to Reduce Thromboembolic Disease in Patients with Total Knee Arthroplasty Surgery?

“…Given the fact that this study is a retrospective review, criticisms toward such a study design are possible. There was no routine monitoring for venous thrombosis, but symptomatic patients were investigated for possible thromboembolic conditions [30]. Owing to the low cases of fatal pulmonary embolus in patients after arthroplasty, it is not possible to compare the mortality rates from pulmonary emboli between the groups.…”

Review Article: Thromboprophylaxis after Total Hip Replacement

“…16,[27][28][29][30][31][32] VTEs can result in a high degree of morbidity and/or mortality related to pelvic and lower-limb deep vein thrombosis (DVT) and pulmonary embolism (PE). 8,[26][27][28]31,[33][34][35][36][37] Without prophylaxis, VTE has an estimated incidence of 40 to 60%, 3,17,[38][39][40] and an event rate warranting medical attention of 1.6 to 6.4%. 8,27,38,40,41 Stratification of the risks to identify patients most in need of vigilant monitoring or aggressive prophylactic therapy has been undertaken.…”

“…Recommendations for the duration of anti-VTE therapy vary from 14 to 42 days, 8,27,28,32,33,37,41,42,[49][50][51][52][53][54] but their translation into clinical practice has been inconsistent. 5,14,49,55,56 After THR, a thromboprophylactic regimen of >14 days has been advocated by many international bodies.…”

“…The incidence of deep vein thrombosis after total hip arthroplasty in patients receiving an extended course of low-molecular-weight heparin versus placebo, with a mean duration being 34 (range, [30][31][32][33][34][35] days. 32 bleeding after conventional anticoagulants has been quoted to be 4 to 5 times higher than with placebo, 37,57 with a significant increase from 2.5 to 3.7% (RR increase=1.56; 95% CI, 1.08-2.26; NNH=83).…”