Effectiveness of Low-molecular-weight heparin in combination with intermittent pneumatic compression against deep venous thrombosis following arthroplasty
BAI Bo1, ZHOU Pu2, CHEN Guodong1, NIU Zengguang1
1.Department of Orthopedics, The First Hospital of Qinhuangdao Qinhuangdao 066000, China; 2.Zibo Vocational Institute Electric And Electronic Engineering,Zibo 255000,China
Abstract:Objective To investigate the effectiveness of intermittent pneumatic compression (IPC) device combined with low molecular weight heparin (LMWH) for the prevention of deep venous thrombosis(DVT) after joint replacement surgery.Methods 80 cases with hip or knee joint peripheral fractures and artificial joint replacements who were admitted to our hospital between January 2015 and January 2016 were randomly divided into two groups. The observation group was treated with low molecular heparin by subcutaneous injection and intermittent pneumatic compression to both lower limbs alternately, while the control group was treated with low molecular heparin alone after operation. The clinical symptoms of venous thromboembolism were observeded, deep venous thrombosis of both lower limbs examined by colour duplex ultrasonography ,and platelet count and blood coagulation were monitored after operation to check the presence of DVT.Results The incidence rates of venous thromboembolism in lower limbs after operation were significantly lower in the observation group than in the control group,so was the amount of bleeding. Pulmonary embolism did not occur in any of the cases. International normalized ratio( INR) did not exceed 2.5 and platelet count did not decrease.Conclusions LMWH in combination with IPC can significantly reduce the incidence of VTE after hip or knee surgery, and is quite safe.
Turpie A G,Levine M N,Hirsh J, et al .A randomized controlled trial of a low-molecular-weight heparin(enoxaparin) to prevent deep-vein thrombosis in patients undergoing elective hip surgery[J].N Engl J Med,1986,315(15):925-929.
[2]
Hull R D,Raskob G E,Gent M, et al .Effectiveness of intermittent pneumatic leg compression for preventing deep vein thrombosis after total hip replacement[J].JAMA,1990,263(17):2313-2317.
[3]
Stone M H,Limb D,Campbell P, et al .A comparison of intermittent calf compression and enoxaparin for thromboprophylaxis in total hip replacement: A pilot study[J].Int Orthop,1996,20(6):367-369.
[4]
Chin P L,Amin M S,Yang K Y, et al .Thromboembolic prophylaxis for total knee arthroplasty in Asian patients:a randomised controlled trial[J].J Orthop Surg(Hong Kong),2009,17(1):1-5.
[5]
Warwick D,Harrison J,Glew D, et al .Comparison of the use of a foot pump with the use of low-molecular-weight heparin for the prevention of deep-vein thrombosis after total hip replacement. A prospective, randomized trial[J].J Bone Joint Surg Am,1998,80(8):1158-1166.
[6]
Hoek J A,Nurmohamed M T,Hamelynck K J, et al .Prevention of deep vein thrombosis following total hip replacement by low molecular weight heparinoid[J].Thromb Haemost,1992,67(1):28-32.
[7]
Lurie F,Awaya D J,Kistner R L, et al .Hemodynamic effect of intermittent pneumatic compression and the position of the body[J].J Vasc Surg,2003,37(1):137-142.
[8]
Geerts W H, Pineo G F, Heit J A, et al . Prevention of venous thromboembolism:the Seventh ACCP Conference on Antithrombotic andThrombolytic Therapy[J]. Chest, 2004, 126 (3 Suppl): 338-400.
[9]
Lynch A F,Bourne R B,Rorabeck C H, et al .Deep-vein thrombosis and continuous passive motion after total knee arthroplasty[J].J Bone Joint Surg Am,1988,70(1):11-14.
[10]
Francis C W.Prevention of VTE in patients having major orthopedic surgery[J].J Thromb Thrombolysis,2013,35(3):359-367.
[11]
Eriksson B I,Kälebo P,Anthymyr B A, et al .Prevention of deepvein thrombosis and pulmonary embolism after total hip replacement. Comparison of lowmolecular-weight heparin and unfractionated heparin[J].J Bone Joint Surg Am,1991,73(4):484-493.
[12]
Mohr D N,Silverstein M D,Ilstrup D M, et al .Venous thromboembolism associated with hip and knee arthroplasty:current prophylactic practices and outcomes[J].Mayo Clin Proc,1992,67(9):861-870.
[13]
Warwick D.New concepts in orthopaedic thromboprophylaxis[J].J Bone Joint Surg Br,2004,86(6):788-792.
Eriksson B I,Kakkar A K,Turpie A G, et al .Oral rivaroxaban for the prevention of symptomatic venous thromboembolism after elective hip and knee replacement[J].J Bone Joint Surg Br,2009,91(5):636-644.
[16]
Silbersack Y,Taute B M,Hein W, et al . Prevention of deep-veinthrombosis after total hip and knee replacement: Low-molecular-weightheparin in combination with intermittent pneumatic compression[J]. J Bone Joint Surg( Br) ,2004,86( 6) : 809-812.
[17]
Molloy D O,Archbold H A,Ogonda L, et al .Comparison of topical fibrin spray and tranexamic acid on blood loss after total knee replacement: a prospective, randomised controlled trial[J].J Bone Joint Surg(Br),2007,89(3):306-309.
[18]
Kohro S,Yamakage M,Sato K, et al . Intermittent pneumatic footcompression can activate blood fibrinolysis without changes in bloodcoagulability and platelet activation[J]. Acta Anaesthesiol Scand,2005,49( 5) : 660-664.
[19]
Turpie A G,Lassen M R,Davidson B L, et al .Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty(RECORD4):a randomised trial[J].Lancet,2009,373(9676):1673-1680.
[20]
Westrich G H,Specht L M,Sharrock N E, et al . Venous haemodynamicsafter total knee arthroplasty: evaluation of active d orsal to plantar flexion and several mec hanical compression devices[J]. J Bone JointSurg( Br) , 1998, 80( 6) : 1057-1066.
[21]
Scaduto A A, Gamradt S C, Warren D Y, et al . Perioperative complicationsof threaded cylindrical lumbar interbody fusion devices:anterior versus posterior approach[J]. J Spinal Disord Tech, 2003, 16( 6) : 502-507.
[22]
Ogbemudia A E,Yee S Y,MacPherson G J, et al .Preoperative predictors for allogenic blood transfusion in hip and knee arthroplasty for rheumatoid arthritis[J].Arch Orthop Trauma Surg,2013,133(9):1315-1320.
[23]
Kumar S, Walker M A. The effects of intermittent pneumatic compression on the arterial and venous system of the lower limb:a review[J].J Tissue Viability,2002,12(2):58-60, 62-66.
[24]
Johansson T,Pettersson L G,Lisander B.Tranexamic acid in total hip arthroplasty saves blood and money: a randomized, double-blind study in 100 patients[J].Acta Orthop,2005,76(3):314-319.
[25]
Roberts V C,Cotton L T.Failure of low-dose heparin to improve efficacy of peroperative intermittent calf compression in preventing postoperative deep vein thrombosis[J].Br Med J,1975,3(5981):458-460.
[26]
Ryu J,Sakamoto A,Honda T, et al .The postoperative drain - clamping method for hemostasis in total knee arthroplasty.Reducing postoperative bleeding in total knee arthroplasty[J].Bull Hosp Jt Dis,1997,56(4):251-254.
[27]
Durasek J,Dovzak-Bajs I,Saric V.Factors affecting blood loss in total knee arthroplasty patients[J].Acta Med Croatica,2010,64(3):209-214.
[28]
Goodman S M,Figgie M.Lower extremity arthroplasty in patients with inflammatory arthritis: preoperative and perioperative management[J].J Am Acad Orthop Surg,2013,21(6):355-363.