Prevention of venous thrombosis after total knee arthroplasty. Comparison of antithrombin III and low-dose heparin with dextran.

Incidence and natural history of deep-vein thrombosis after total knee arthroplasty

“…Although the subgroup of patients with rheumatoid arthritis is too small to allow a proper statistical analysis, our findings indicate that there is no specific correlation between the types of arthritis and the incidence of DVT. 1,8,9,14,25 Contrary to the reports by Stulberg et al, 14 our study shows that the incidence of DVT has no correlation with either one-stage bilateral or unilateral replacement. This finding agrees with that of Morrey et al 26 Also, contrary to the findings of Liu et al, 27 we found no significant difference in the incidence of thrombosis between patients with anatomical venous variations and those without, or between patients with more than five valves and those with fewer.…”

“…Our findings confirm those of Kim and Suh, 28 and lead us to believe that there is no correlation between venous stasis and thrombosis. Francis et al 25 and Stulberg et al 14 suggested that there was a possible correlation between antithrombin-III activity and the occurrence of DVT after a cemented total knee replacement. Others, 8,9,27,28 however, found no such correlation and our findings support this conclusion.…”

“…Our findings did not confirm the view that hyperlipidaemia is not only associated with accelerated blood clotting, but also with increased blood viscosity and adhesiveness and aggregation of red blood cells. 30 Most authors agree that patients with proximal thrombi are at the greatest risk of suffering symptomatic pulmonary embolism, 19,20,31,32 but the clinical significance of calf thrombi is disputed with some authors suggesting that asymptomatic calf thrombi pose little or no increased risk 8,9,20,24,25 and others reporting an increased risk. 3,10,13,19,33 In order to develop an effective protocol for the treatment of thromboembolic disease, the natural history of calf and proximal thrombi must be defined.…”

The tourniquet in total knee arthroplasty

“…13 Its use may, theoretically, increase the risk of deep-venous thrombosis (DVT) by causing venous stasis, direct trauma to the vessel wall or increased platelet adhesion in the valve pockets after distal limb ischaemia. 14,15 Abdel-Salam and Eyres 8 reported an increased incidence of wound complications, more postoperative pain, and delays in recovery of muscle power with the use of a tourniquet in total knee arthroplasty (TKA). There was also a higher rate of DVT.…”

Drug prophylaxis of deep vein thrombosis in traumatology: is there a benefit of a score in outpatients?

“…Strategies for preventing deep vein thrombosis (DVT) must be judged by their reduction in its incidence of DVT [7,17,18]. We have used drug prophylaxis of DVT in outpatients as a routine procedure since 1992.…”