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Prophylaxis against deep-vein thrombosis in total hip replacement. Comparison of heparin and foot impulse pump
F S Santori1, A Vitullo, M Stopponi
1Department of Orthopaedics and Traumatology, San Pietro Fatebenefratelli Hospital, Rome, Italy.
Insights
The A-V Impulse System significantly reduced deep-vein thrombosis (DVT) after hip replacement compared to heparin. This mechanical compression device is a safer alternative, lowering major thromboses and bleeding risks.
Area of Science:
- Orthopedic Surgery
- Vascular Surgery
- Thrombosis Research
Background:
- Deep-vein thrombosis (DVT) is a significant risk following total hip replacement surgery.
- Heparin prophylaxis is commonly used but associated with bleeding complications.
- Alternative methods for DVT prevention are needed.
Purpose of the Study:
- To compare the efficacy and safety of the A-V Impulse System versus calcium heparin in preventing DVT.
- To evaluate the incidence of major and minor DVT, pulmonary embolism, and bleeding complications.
Main Methods:
- A randomized controlled study involving 132 patients undergoing total hip replacement.
- Patients received either calcium heparin (65) or the A-V Impulse System (67) post-operatively, along with compression stockings.
- Deep-vein thrombosis was diagnosed using Doppler ultrasound, thermography, and phlebography.
Main Results:
- The A-V Impulse System group had a significantly lower incidence of DVT (13.4%) compared to the heparin group (35.4%) (p < 0.005).
- Major DVT rates were also significantly lower in the impulse pump group (4.5%) versus the heparin group (24.6%).
- No fatal pulmonary embolism or significant bleeding complications occurred in the impulse pump group, unlike the heparin group (one fatal PE, 13.8% bleeding complications).
Conclusions:
- The A-V Impulse System is a more effective and safer method for preventing DVT after total hip replacement than calcium heparin.
- Mechanical prophylaxis with the A-V Impulse System reduces the risk of major thrombotic events and associated bleeding complications.
Abstract:
We performed a randomised controlled study to compare heparin with the A-V Impulse System in the prevention of deep-vein thrombosis (DVT) in 132 consecutive patients undergoing total hip replacement. After the operation, all patients had compression stockings, 65 were treated with calcium heparin and 67 with the intermittent plantar pump. DVT was diagnosed by Doppler ultrasound and thermography, followed by phlebography. There were 23 cases of DVT (35.4%) in the heparin group, with 16 major and seven minor thromboses. In the impulse pump group there were nine cases (13.4%) with three major and six minor thromboses. The differences for all thromboses and for major thromboses were both significant at p < 0.005. In the heparin group there was one fatal pulmonary embolism and nine patients (13.8%) had excessive bleeding or wound haematomas, as against none in the impulse pump group.