Current concepts in the prevention, detection, and treatment of deep vein thrombosis in total hip and knee replacement.
In hip replacement, prophylaxis of thromboembolism with warfarin to 1.5 times control with respect to prothrombin time remains efficacious. Further reduction of the dosage has not met with success. Confirmatory studies on the usefulness of adjusted-dose heparin and low molecular weight heparin continue. Promising new methods include intravenous intraoperative heparin, intermittent pneumatic compression alone, and the combination of antithrombin III and fixed-dose heparin. It is now recognized that knee replacement carries a similar risk of thromboembolism as hip replacement. Recent work has demonstrated the effectiveness of sequential pneumatic compression, adjusted-dose heparin, and the combination of antithrombin III and fixed-dose heparin. Venography remains the gold standard for detection of deep vein thrombosis. Recent interest has centered around the use of the less invasive technique of ultrasound. Anticoagulation with intravenous heparin followed by oral warfarin remains standard treatment for proximal thrombi and also distal deep vein thrombosis, in which serial screening methods for proximal extension are unavailable.
Yen
D
D
University of Toronto, Ontario, Canada.
D000925:Anticoagulants / Q000494:pharmacology; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D013924:Thrombophlebitis / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy
D000925:Anticoagulants