Anticoagulation Therapy With Heparin and Warfarin in Total Knee Arthroplasty for Osteoarthritis Knee

Abstract

The authors evaluated the prophylactic protocols with unfractionated heparin (UFH) and warfarin in Japanese patients who underwent total knee arthroplasty (TKA) for osteoarthritis knee in regard to bleeding complications. Fifty-six patients who underwent TKA for osteoarthritis knee with the use of methylmethacrylate were included. Subcutaneous UFH and warfarin were administered for thromboprophylaxis to the first group of 26 patients. The second group of 30 patients did not receive any pharmacological thromboprophylaxis and were used as controls. No significant differences were found between the 2 groups for operative and postoperative blood loss. There were no cases with major bleeding as a complication, but for 2 cases, the international normalized ratio high value exceeded the remedy limits, and temporary dosage discontinuance was required. There were no clinically important bleeding events in the 2 groups. No heparin-induced thrombocytopenia or warfarin-induced skin necrosis occurred. The authors conclude that the protocol with UFH and warfarin is safe for thromboprophylaxis against deep venous thrombosis and pulmonary embolism after TKA in Japanese patients, but its efficacy can only be resolved with further studies.

A Study of Coagulation Changes at Early Stage after Total Knee Arthroplasty

“…[2][3][4][5] The reported data show that 10 to 30% of patients have encountered asymptomatic or symptomatic DVT after TKA surgery, detected by color Doppler ultrasonography or radionuclide venography. [6][7][8][9][10] Therefore, prophylactic treatment of anticoagulation is commonly accepted as standard postoperative procedure, [11][12][13] which applies anticoagulation medicine 12 to 24 hours after operation. The time window of anticoagulation application is meant to avoid the increased bleeding caused by early anticoagulation prophylaxis, therefore to reduce the need of blood transfusion.…”