Thromboprophylaxis-in-hip arthroplasty: Dextran with graded compression or preoperative dextran compared in 150 patients

Fredin, Hans; Bergqvist, David; Cederholm, C; Lindblad, Bengt; Nyman, Ulf

doi:10.3109/17453678909149602

Cited by 35 publications

(20 citation statements)

References 15 publications

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“…[42][43][44][45] Background (pharmacologic) prophylaxis included LDUH in fi ve studies, dextran in three studies, LMWH in one study, and aspirin in one study. Many of the studies were limited by small samples, incomplete blinding, uncertain concealment of the allocation sequence, and measurement of surrogate outcomes (Table S4).…”

Section: Mechanical Prophylaxis Plus Pharmacologic Prophylaxis Vs Phamentioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,827

744

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(Grade 2C) prophylaxis be used other than early ambulation. For patients at low risk for VTE ( ‫ف‬ 1.5%), we suggest mechanical prophylaxis, preferably with intermittent pneumatic compression (IPC), over no prophylaxis (Grade 2C). For patients at moderate risk for VTE ( ‫ف‬ 3%) who are not at high risk for major bleeding complications, we suggest low-molecular-weight heparin (LMWH) (Grade 2B), low-dose unfractionated heparin (Grade 2B), or mechanical prophylaxis with IPC (Grade 2C) over no prophylaxis. For patients at high risk for VTE ( ‫ف‬ 6%) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with LMWH (Grade 1B) or low-dose unfractionated heparin (Grade 1B) over no prophylaxis. In these patients, we suggest adding mechanical prophylaxis with elastic stockings or IPC to pharmacologic prophylaxis (Grade 2C). For patients at high risk for VTE undergoing abdominal or pelvic surgery for cancer, we recommend extended-duration, postoperative, pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis (Grade 1B). For patients at moderate to high risk for VTE who are at high risk for major bleeding complications or those in whom the consequences of bleeding are believed to be particularly severe, we suggest use of mechanical prophylaxis, preferably with IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated (Grade 2C). For patients in all risk groups, we suggest that an inferior vena cava fi lter not be used for primary VTE prevention (Grade 2C) and that surveillance with venous compression ultrasonography should not be performed (Grade 2C). We developed similar recommendations for other nonorthopedic surgical populations. Conclusions: Optimal thromboprophylaxis in nonorthopedic surgical patients will consider the risks of VTE and bleeding complications as well as the values and preferences of individual patients. CHEST 2012; 141(2)(Suppl):e227S-e277SAbbreviations: CABG 5 coronary artery bypass graft; ES 5 elastic stockings; ICH 5 intracranial hemorrhage; IPC 5 intermittent pneumatic compression; IVC 5 inferior vena cava; LDUH 5 low-dose unfractionated heparin; LMWH 5 low-molecular-weight heparin; PE 5 pulmonary embolism; QALY 5 quality-adjusted life year; RR 5 risk ratio; VCU 5 venous compression ultrasonography

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Section: Mechanical Prophylaxis Plus Pharmacologic Prophylaxis Vs Phamentioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,827

744

View full text Add to dashboard Cite

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“…The majority of trials assessing compression methods were conducted in a surgical setting: 14 were orthopaedic, 24,33,34,36,40,48,49,[51][52][53]59,60,63,64 16 general, 23,25,26,28,29,32,[37][38][39]41,42,44,50,54,61,62 six neurosurgical or after spinal surgery, 31,43,[55][56][57][58] three gynaecological 30,45,46 and one mixed surgical, 47 with only two trials 27,35 conducted among 257 medical patients at high risk of venous thromboembolism. After subdividing these trials into those assessing monotherapy and those assessing adjunctive therapy, the specific type of surgical or medical setting did not appear to influence the effectiveness of mechanical compression [heterogeneity 2 for monotherapy (on 5 df) = 4.6; p > 0.1, and heterogeneity 2 for adjunctive therapy (on 2 df) = 3.7; p > 0.1, not significant (NS); Figure 2].…”

Section: Description Of Trialsmentioning

confidence: 99%

“…Twelve trials [32][33][34][35][36][37][38][39][59][60][61]64 among 1694 patients had assessed the addition of a mechanical compression method to a pharmacological agent (heparin, dextran or aspirin). Mechanical compression as adjunctive therapy produced a highly significant reduction in DVT [53% (10) reduction; 2p < 0.00001; Figure 1].…”

Section: Effects Of Mechanical Compression As Adjunctive Therapy To Amentioning

confidence: 99%

Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis

Roderick¹,

Ferris²,

Wilson³

et al. 2005

Health Technol Assess

266

151

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“…In a recent meta-analysis of papers published in the last 30 years, Wells, Lensing and Hirsh (1994) identified only 12 articles which fulfilled their criteria for prospective, randomised trials, and of these only one was on patients undergoing joint replacement (Fredin et al 1989). The conclusions strongly favoured the use of compression stockings, the only exception being the orthopaedic study in which no statistically significant benefit had been demonstrated.…”

Section: J Bone Joint Surgmentioning

confidence: 99%

Graded Compression Stockings for Prevention of Deep-Vein Thrombosis After Hip and Knee Replacement

Hui

Heras-Palou

Dunn

et al. 1996

The Journal of Bone and Joint Surgery. British volume

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We performed a prospective, randomised controlled trial in 177 patients who were having either total hip or knee replacement, to evaluate the use of both above-and below-knee graded compression stockings in the prevention of deep-vein thrombosis (DVT).With above-knee stockings, we found no significant reduction of the overall, proximal or major calf (> 5 cm) DVT rates. With below-knee stockings, the overall thrombosis rate was similar to that of the control group but the stockings appeared to have altered the pattern of thrombosis. Patients who had total hip replacement and wore below-knee stockings had a significantly higher rate of proximal or major calf DVT (p = 0.03). This pattern was reversed in patients with total knee replacement who developed a significantly lower rate of proximal or major calf DVT with below-knee stockings (p < 0.05).Our results showed that, with the exception of below-knee stockings in knee replacement patients, graded compression stockings were ineffective in preventing DVT after hip or knee replacement surgery.

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Thromboprophylaxis-in-hip arthroplasty: Dextran with graded compression or preoperative dextran compared in 150 patients

Cited by 35 publications

References 15 publications

Prevention of VTE in Nonorthopedic Surgical Patients

Prevention of VTE in Nonorthopedic Surgical Patients

Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis

Graded Compression Stockings for Prevention of Deep-Vein Thrombosis After Hip and Knee Replacement

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