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Thromboprophylaxis and death after total hip replacement
D W Murray1, A R Britton, C J Bulstrode
1Nuffield Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre, Headington, Oxford, UK.
The Journal of Bone and Joint Surgery. British Volume
|November 1, 1996
Summary
Pharmacological thromboprophylaxis after total hip replacement may not significantly decrease death rates. Fatal pulmonary embolism is less common than believed, suggesting limited benefits may not outweigh risks.
Area of Science:
- Orthopedic Surgery
- Vascular Medicine
- Medical Statistics
Background:
- Current guidelines recommend pharmacological thromboprophylaxis for total hip replacement patients.
- This recommendation is based on the perceived high incidence of fatal pulmonary embolism and the presumed efficacy of prophylaxis.
Purpose of the Study:
- To investigate the actual incidence of fatal pulmonary embolism after total hip replacement.
- To evaluate the effectiveness of pharmacological thromboprophylaxis in reducing mortality rates in these patients.
Main Methods:
- A meta-analysis was conducted on studies involving total hip replacement patients.
- Data on mortality and fatal pulmonary embolism from approximately 130,000 patients were analyzed.
- Study quality and content variations were noted as limitations.
Main Results:
- The rate of fatal pulmonary embolism in patients without prophylaxis was 0.1% to 0.2%, lower than commonly cited.
- The overall death rate was 0.3% to 0.4%, with no significant reduction observed with heparin or other prophylactic agents.
- The potential benefit of prophylaxis appears small and may not justify associated risks.
Conclusions:
- There is insufficient evidence to support the routine use of pharmacological thromboprophylaxis to decrease death rates after total hip replacement.
- Current guidelines recommending routine prophylaxis for preventing death post-hip replacement may not be justified based on available data.