Clifford W Colwell1, Mark I Froimson2, Scott D Anseth3, Nicholas J Giori4, William G Hamilton5, Robert L Barrack6, Knute C Buehler7, Michael A Mont8, Douglas E Padgett9, Pamela A Pulido1, C Lowery Barnes10. 1. Shiley Center for Orthopaedic Research and Education at Scripps Clinic, 11025 North Torrey Pines Road, Suite 200, La Jolla, CA 92037. E-mail address for C.W. Colwell Jr.: colwell@scripps.edu. 2. Euclid Cleveland Clinic, Euclid Hospital - Administration, 18901 Lake Shore Boulevard, Euclid, OH 44119. 3. Twin Cities Orthopaedics, 4010 West 65th Street, Edina, MN 55435. 4. VA Palo Alto Health Care System, 3801 Miranda Avenue (112), Palo Alto, CA 94304. 5. Anderson Orthopaedic Clinic, 2501 Parkers Lane, Alexandria, VA 22306. 6. Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 South Euclid Avenue, St. Louis, MO 63110. 7. The Center, Orthopedic & Neurosurgical Care & Research, 2200 N.E. Neff Road, Suite 200, Bend, OR 977041-4281. 8. Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. 9. Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021-4892. 10. Arkansas Specialty Orthopaedics, 1701 Aldersgate Road, Suite 3, Little Rock, AR 72205.
Abstract
BACKGROUND: Venous thromboembolic events, either deep venous thrombosis or pulmonary embolism, are important complications in patients undergoing knee or hip arthroplasty. The purpose of this study was to evaluate the effectiveness of a mobile compression device (ActiveCare+S.F.T.) with or without aspirin compared with current pharmacological protocols for prophylaxis against venous thromboembolism in patients undergoing elective primary unilateral arthroplasty of a lower-extremity joint. METHODS: A multicenter registry was established to capture the rate of symptomatic venous thromboembolic events following primary knee arthroplasty (1551 patients) or hip arthroplasty (1509 patients) from ten sites. All patients were eighteen years of age or older with no known history of venous thromboembolism, coagulation disorder, or solid tumor. Use of the compression device began perioperatively and continued for a minimum of ten days. Patients with symptoms of deep venous thrombosis or pulmonary embolism underwent duplex ultrasonography and/or spiral computed tomography. All patients were evaluated at three months postoperatively to document any evidence of deep venous thrombosis or pulmonary embolism. RESULTS: Of 3060 patients, twenty-eight (0.92%) had venous thromboembolism (twenty distal deep venous thrombi, three proximal deep venous thrombi, and five pulmonary emboli). One death occurred, with no autopsy performed. Symptomatic venous thromboembolic rates observed in patients who had an arthroplasty of a lower-extremity joint using the mobile compression device were noninferior (not worse than), at a margin of 1.0%, to the rates reported for pharmacological prophylaxis, including warfarin, enoxaparin, rivaroxaban, and dabigatran, except in the knee arthroplasty group, in which the mobile compression device fell short of the rate reported for rivaroxaban by 0.06%. CONCLUSIONS: Use of the mobile compression device with or without aspirin for patients undergoing arthroplasty of a lower-extremity joint provides a noninferior risk for the development of venous thromboembolism compared with current pharmacological protocols.
BACKGROUND:Venous thromboembolic events, either deep venous thrombosis or pulmonary embolism, are important complications in patients undergoing knee or hip arthroplasty. The purpose of this study was to evaluate the effectiveness of a mobile compression device (ActiveCare+S.F.T.) with or without aspirin compared with current pharmacological protocols for prophylaxis against venous thromboembolism in patients undergoing elective primary unilateral arthroplasty of a lower-extremity joint. METHODS: A multicenter registry was established to capture the rate of symptomatic venous thromboembolic events following primary knee arthroplasty (1551 patients) or hip arthroplasty (1509 patients) from ten sites. All patients were eighteen years of age or older with no known history of venous thromboembolism, coagulation disorder, or solid tumor. Use of the compression device began perioperatively and continued for a minimum of ten days. Patients with symptoms of deep venous thrombosis or pulmonary embolism underwent duplex ultrasonography and/or spiral computed tomography. All patients were evaluated at three months postoperatively to document any evidence of deep venous thrombosis or pulmonary embolism. RESULTS: Of 3060 patients, twenty-eight (0.92%) had venous thromboembolism (twenty distal deep venous thrombi, three proximal deep venous thrombi, and five pulmonary emboli). One death occurred, with no autopsy performed. Symptomatic venous thromboembolic rates observed in patients who had an arthroplasty of a lower-extremity joint using the mobile compression device were noninferior (not worse than), at a margin of 1.0%, to the rates reported for pharmacological prophylaxis, including warfarin, enoxaparin, rivaroxaban, and dabigatran, except in the knee arthroplasty group, in which the mobile compression device fell short of the rate reported for rivaroxaban by 0.06%. CONCLUSIONS: Use of the mobile compression device with or without aspirin for patients undergoing arthroplasty of a lower-extremity joint provides a noninferior risk for the development of venous thromboembolism compared with current pharmacological protocols.
Authors: Eric S Wise; Stephen P Gadomski; William G McMaster; Robert J Wilson; Justin K Nelms; Kyle M Hocking; Colleen M Brophy Journal: J Orthop Date: 2015-11-28
Authors: Brett T Venker; Beejal R Ganti; Hannah Lin; Elizabeth D Lee; Ryan M Nunley; Brian F Gage Journal: J Arthroplasty Date: 2016-10-05 Impact factor: 4.757