Safety of a clinical surveillance protocol with 3- and 6-week warfarin prophylaxis after total joint arthroplasty

Area of Science:

• Orthopedic Surgery
• Vascular Surgery
• Thromboprophylaxis

Background:

• Deep venous thrombosis (DVT) and pulmonary embolism (PE) are significant risks following major orthopedic procedures like total hip or knee arthroplasty.
• Effective prophylaxis is crucial to minimize patient morbidity and mortality.

Purpose of the Study:

• To evaluate the efficacy of a specific prophylaxis protocol in preventing DVT and PE after total hip or knee arthroplasty.
• To assess the incidence of DVT and PE in patients undergoing arthroplasty with the implemented protocol.

Main Methods:

• Retrospective chart review of 1869 patients undergoing total hip or knee arthroplasty.
• Prophylaxis included low-dose warfarin (3 or 6 weeks), pneumatic compression boots, early mobilization, and clinical surveillance.
• Diagnostic imaging (venous ultrasound, V/Q scan) was performed only for symptomatic patients.

Main Results:

• Overall DVT incidence was 1.8% (23/1869) and PE incidence was 0.4% (5/1869).
• In the 6-week warfarin group, 3% (19/634) had DVT and 0.16% (1/634) had PE.
• No fatal PE or postphlebitic syndrome was reported.

Conclusions:

• The described prophylaxis protocol is effective in preventing major thromboembolic events after hip and knee arthroplasty.
• The protocol demonstrates efficiency and cost-effectiveness in reducing significant post-operative complications.