Failure of the American College of Chest Physicians-1A Protocol for Lovenox in Clinical Outcomes for Thromboembolic Prophylaxis
Department of Orthopaedic Surgery, Washington University in St. Louis, San Luis, Missouri, United States The Journal of Arthroplasty
(Impact Factor: 2.67).
04/2007; 22(3):317-24. DOI: 10.1016/j.arth.2007.01.007
A total of 290 consecutive patients who underwent total hip and total knee arthroplasty were prospectively entered into a clinical anticoagulation trial using a 10-day course of Lovenox with the American College of Chest Physicians-1A guidelines. Major complications occurred in 9% of patients; symptomatic deep vein thrombosis occurred in 9 (3.8%) patients, and nonfatal pulmonary embolism in 3 (1.3%) patients. Complications included 4.7% readmissions, 3.4% return to the operating room for wound incision and drainage, 5.1% prolonged hospitalization (wound drainage), and 3.4% injection site complications. Wound drainage of more than 7 days was predictive of readmission and wound reoperation. A body mass index of more than 35 was predictive of prolonged wound drainage. Return to the operating room for wound complications occurred 3x more frequently with the use of Lovenox than in our previous study using warfarin. Surgical site complications requiring readmission or reoperation should be considered "major" complications.
Available from: Kang-Il Kim
- "Any pharmacological thromboprophylaxis use places the patient at risk of bleeding and its sequelae28). The risks associated with thromboprophylaxis are varied and include hemorrhage, wound hematoma, persisting wound drainage, failure of wound healing, risk of infection and blood loss requiring transfusion33,34). Bleeding is categorized as major if it is clinically overt or if it is retroperitoneal, intracranial, or intraocular in location, results in death or a serious or life-threatening clinical event or one requiring surgical intervention35). "
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ABSTRACT: Postoperative venous thromboembolism is one of the most serious complications following total joint arthroplasty. Pharmacological and mechanical prophylaxis methods are used to reduce the risk of postoperative symptomatic deep vein thrombosis and pulmonary embolism. Use of pharmacological prophylaxis requires a fine balance between the efficacy of the drug in preventing deep vein thrombosis and the adverse effects associated with the use of these drugs. In regions with a low prevalence of deep vein thrombosis such as Korea, there might be a question whether the benefits of using pharmacological prophylaxis outweigh the risks involved. The current article reviews the need for thromboprophylaxis, guidelines, problems with the guidelines, pharmacological prophylaxis use, and the current scenario of deep vein thrombosis, and discusses whether the use of pharmacological prophylaxis should be mandatory in low incidence populations.
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