Ultrasonographic screening before hospital discharge for deep venous thrombosis after arthroplasty: the post-arthroplasty screening study. A randomized, controlled trial.
BACKGROUND
The clinical significance of asymptomatic deep venous thrombosis that develops after joint arthroplasty and the value of screening tests to detect thrombi are uncertain.


OBJECTIVE
To determine 1) the rate of symptomatic deep venous thrombosis or pulmonary embolism occurring after hospitalization for joint arthroplasty and 2) the value of screening compression ultrasonography.


METHODS
Double-blind, randomized, controlled trial.


METHODS
Tertiary care hospital.


METHODS
1024 patients undergoing elective total hip or knee arthroplasty who received warfarin prophylaxis.


METHODS
Patients were randomly assigned to undergo either bilateral compression ultrasonography or a sham procedure before hospital discharge. Patients with a diagnosis of asymptomatic deep venous thrombosis were treated after discharge with standard anticoagulant therapy; other patients had warfarin therapy discontinued at discharge. All patients were followed for 90 days.


RESULTS
In the screening group, asymptomatic proximal deep venous thrombosis was detected in 13 of 518 patients (2.5%). Another 4 patients subsequently developed symptomatic proximal deep venous thrombosis, and 1 patient treated for asymptomatic deep venous thrombosis developed major bleeding, for a total outcome event rate of 1.0% (5 of 518 patients). In the placebo group, 3 patients developed symptomatic proximal deep venous thrombosis and 2 had nonfatal pulmonary embolism, for a total event rate of 1.0% (5 of 506 patients) (difference, 0 percentage points [95% CI, -1.2 to 1.2 percentage points]).


CONCLUSIONS
In patients undergoing total hip or knee arthroplasty, the use of warfarin prophylaxis during hospitalization results in a very low rate of symptomatic deep venous thrombosis or pulmonary embolism after hospital discharge. The use of screening compression ultrasonography at hospital discharge does not seem to be justified in this setting.
Robinson
K S
KS
Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
Anderson
D R
DR
Gross
M
M
Petrie
D
D
Leighton
R
R
Stanish
W
W
Alexander
D
D
Mitchell
M
M
Flemming
B
B
Gent
M
M
D000465:Algorithms; D000925:Anticoagulants / Q000627:therapeutic use; D004311:Double-Blind Method; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced; D006622:Hip Prosthesis; D006801:Humans; D007720:Knee Prosthesis; D010351:Patient Discharge; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000517:prevention & control; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000517:prevention & control; D013924:Thrombophlebitis / Q000000981:diagnostic imaging* / Q000517:prevention & control; D016896:Treatment Outcome; D014463:Ultrasonography; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin