Prevention of deep vein thrombosis after total knee arthroplasty. Coumadin versus pneumatic calf compression.
The rate of deep vein thrombosis (DVT) after total knee arthroplasty (TKA) without prophylaxis has been reported as high as 84%. Coumadin anticoagulation and pneumatic calf compression (PCC) boots are two current therapies that have been thought to be effective in reducing this high rate of DVT. To investigate these two methods, a nonrandomized prospective study was designed. The first group involved treating 48 consecutive knee arthroplasties with a regimen of coumadin anticoagulation. The second group involved 81 consecutive knee arthroplasties treated with sequential PCC boots. Bilateral lower extremity venography was performed between the eighth and tenth hospital postoperative days. The overall incidence of DVT in the coumadin group was 33%, with 29% having calf thrombi and 6% having thigh thrombi. The overall incidence of DVT in the boot group was 31%, with 27% having calf thrombi and 6% having thigh thrombi. In both groups, there were no treatment-related complications. Cost analysis of the administration of each type of therapy showed coumadin to be approximately 50% more expensive than PCC boots. Although coumadin and PCC boot therapy are safe and effective in reducing the incidence of DVT after TKA, there are economic factors that make the latter a more favorable option.
Massachusetts General Hospital, Boston 02114.
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Hodge
D005260:Female; D005676:Gravity Suits / Q000191:economics; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D013924:Thrombophlebitis / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000191:economics / Q000627:therapeutic use*
D014859:Warfarin