Femoral vein thrombosis and total hip replacement.

Stamatakis, J. D.; Vv, Kakkar; S, Sagar; Lawrence, David M.; Nairn, David; Bentley, P G

doi:10.1136/bmj.2.6081.223

Cited by 216 publications

(41 citation statements)

References 13 publications

(1 reference statement)

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“…Our intraoperative phlebography studies confirm those of Stamatakis et al [17] who demonstrated that occlusion of the proximal portion of the femoral vein occurs during hip replacement. As venous stasis is implicated in thrombosis, manoeuvres of the hip joint which result in kinking of the femoral vein, notably internal rotation of the hip when flexed at 40 degrees, should be kept to a minimum.…”

Section: Discussionsupporting

confidence: 80%

Prophylaxis for deep vein thrombosis with aspirin or low molecular weight dextran in Korean patients undergoing total hip replacement;a randomized controlled trial

Kim

Choi

Park

et al. 1998

International Orthopaedics

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Section: Discussionsupporting

confidence: 80%

Prophylaxis for deep vein thrombosis with aspirin or low molecular weight dextran in Korean patients undergoing total hip replacement;a randomized controlled trial

Kim

Choi

Park

et al. 1998

International Orthopaedics

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“…However, the sensitivity of monolateral phlebography is very close to the bilateral one, since only a small number (!10%) of DVT occurrs in the nonoperated limb, most invariably localized in the calf [28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Prolonged Prophylaxis with Unfractioned Heparin Is Effective to Reduce Delayed Deep Vein Thrombosis in Total Hip Replacement

Manganelli

Pazzagli²,

Mazzantini³

et al. 1998

Respiration

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The aim of this study was to assess the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) until 45 days after elective total hip replacement (THR) and the efficacy of prolonged unfractioned heparin (UH) prophylaxis up to postoperative day 30. To this end 79 of 96 patients admitted consecutively to the University Hospital of Pisa for THR were randomly assigned to short- or long-term UH prophylaxis. Sixty-one patients completed the study: 28 of them received short-term prophylaxis (subcutaneous UH 15,000 IU/24 h for 15 days) and 33 prolonged prophylaxis (subcutaneous UH 15,000 IU/24 h for 30 days). Lower limb phlebography was performed in all patients on day 45 after THR. DVT was demonstrated in 10 (16.3%) cases after hospital discharge. Among them, 2 patients also had symptomatic PE. The incidence of DVT was 21.4% in short- and 12.1% in long-term UH-treated patients. The incidence of only proximal DVT was 17.8% in short- and 3.0% in long-term UH-treated patients; although the difference was only close to significance (p = 0.085), the relative risk of developing proximal DVT was about six times greater in the former group of patients. We concluded that the risk for thromboembolism persists at least until 45 days after surgery in patients subjected to THR. Prophylaxis with UH given up to postoperative day 30 appears more effective and safer in reducing the delayed thromboembolic risk compared to prophylaxis with UH given up to discharge only.

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“…Patients who undergo major surgery with all of the above risk factors tend to develop DVT as a result of a variety of factors, including surgical injury and limb activity restriction. A previous study showed that in patients who underwent major hip or knee surgery without anticoagulation treatment, the incidence of DVT was 45%-84% [11]. As the population ages, there will be a corresponding increase in joint replacement surgeries, and the incidence of postoperative DVT is also likely to gradually increase [12].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and Tolerability of Anticoagulants for Thromboprophylaxis after Major Joint Surgery: a Network Meta-Analysis

Wang¹,

Zheng²,

Zhao³

et al. 2017

Cell Physiol Biochem

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Background/Aims: Venous thromboembolism (VTE) is the most common complication after major joint surgery. VTE can easily develop into pulmonary embolism (PE), leading to cardiopulmonary dysfunction or sudden death. We aimed to comprehensively analyse the thromboprophylactic drugs that are used to prevent thrombosis and reduce bleeding risk. Methods: We searched the PubMed, EMBASE, and Cochrane databases for randomized controlled trials that evaluated the use of thromboprophylaxis after major joint surgery. The major outcomes were the numbers of all-cause VTE and bleeding events, and the secondary outcomes were major VTE and major bleeding/clinically relevant non-major bleeding events. A random-effects network meta-analysis was used to assess the effectiveness and tolerability of each anticoagulant after major joint surgery. Results: We included 104 trials that assessed 110,643 patients in our meta-analysis. The cluster ranking of major outcomes indicated that FXI-ASO, ardeparin, aspirin, and apixaban were ideal for preventing all-cause VTE and avoiding all bleeding events. Nadroparin, recombinant hirudin, and rivaroxaban effectively inhibited VTE but were associated with a high risk of bleeding. For secondary outcomes, we found that betrixaban, dalteparin, warfarin, and eribaxaban were ideal for preventing major VTE and reducing major bleeding, while rivaroxaban effectively inhibited major VTE but was associated with a high risk of major/clinically relevant non-major bleeding. A sensitivity analysis showed that the effect of apixaban was more robust for major outcomes, while aspirin was more robust for preventing all-cause bleeding events. In secondary outcomes, the effect of warfarin was more robust, while apixaban was still considered an ideal treatment to inhibit major VTE and bleeding events. Conclusion: Our study indicates that FXI-ASO, ardeparin, aspirin, and apixaban are ideal for preventing all-cause VTE and reducing all bleeding events, among which apixaban is the most reliable. Betrixaban, dalteparin, warfarin, and eribaxaban are ideal for preventing major VTE and reducing major/clinically relevant non-major bleeding events, among which warfarin is the most reliable.

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Femoral vein thrombosis and total hip replacement.

Cited by 216 publications

References 13 publications

Prophylaxis for deep vein thrombosis with aspirin or low molecular weight dextran in Korean patients undergoing total hip replacement;a randomized controlled trial

Prophylaxis for deep vein thrombosis with aspirin or low molecular weight dextran in Korean patients undergoing total hip replacement;a randomized controlled trial

Prolonged Prophylaxis with Unfractioned Heparin Is Effective to Reduce Delayed Deep Vein Thrombosis in Total Hip Replacement

Effectiveness and Tolerability of Anticoagulants for Thromboprophylaxis after Major Joint Surgery: a Network Meta-Analysis

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