The post-hospital discharge venous thrombosis risk of the orthopedic patient

A prospective, randomized, double-blind trial was performed in total hip replacement patients to document the risk of deep vein thrombosis (DVT) after hospital discharge, and to assess the efficacy of sustained antithrombotic prophylaxis. In a total of 179 patients receiving enoxaparin 40 mg/day during hospitalization, those without venogram-proven DVT at discharge were randomly assigned to continue prophylaxis with enoxaparin (N = 90) or receive placebo (N = 89). At the end of 21 days' treatment, intention-to-treat analysis in 173 evaluable patients demonstrated a significantly lower incidence (P = 0.018) of DVT in the enoxaparin group (7.1%; N = 6) compared with the placebo group (19.3%; N = 17). These findings were confirmed by perprotocol analysis in 155 patients. Minor bleeding episodes occurred in three patients in the enoxaparin group and one in the placebo group. Thus, total hip replacement patients have a significant risk of developing DVT after hospital discharge. Continued prophylaxis with enoxaparin is effective in reducing this risk.