Prevention of venous thromboembolism after knee arthroscopy with low-molecular weight heparin (reviparin): Results of a randomized controlled trial.
OBJECTIVE
Deep venous thrombosis (DVT) is a common, important complication of major orthopaedic surgery, particularly knee arthroplasty. Knee arthroscopy is increasingly performed on an outpatient basis. Few reports have elucidated the incidence of venous thromboembolism (VTE) in patients undergoing arthroscopic surgery receiving no prophylaxis. The objective of the present trial was to evaluate the risk of VTE in those patients and to determine efficacy and safety of a low-molecular weight heparin (LMWH) in preventing VTE.


METHODS
This is the first controlled randomized trial using objective diagnostic methods with blinded outcome assessment to reveal the incidence of VTE in outpatient arthroscopy and determine efficacy and safety of a LMWH (reviparin sodium) in preventing VTE in these patients.


METHODS
There were 262 patients undergoing elective knee arthroscopy prospectively randomized to receive either no treatment or reviparin once daily subcutaneously for 7 to 10 days. The blindly assessed primary outcome measure was the incidence of DVT detected by compression color-coded sonography. Both groups were comparable with regard to demographics and baseline characteristics.


RESULTS
239 patients were evaluable (122 no treatment, 117 receiving LMWH). 6 DVT were detected - 5 in the control group (5/117 - 4.1%) and only one in the active treatment group (1/116 - 0.85%). This particular patient had a low level of protein C and a subnormal level of protein S. The odds ratio of 4.95 approximates a relative risk reduction of about 80%. Treatment with reviparin was safe and well tolerated. There was no major bleeding, four patients with minor bleedings. One patient had a transitory fall in platelet count below 100 giga-particles/L without any clinical symptoms.


CONCLUSIONS
Patients undergoing knee arthroscopy have a moderate risk of VTE and effective prophylaxis can be achieved with LMWH (reviparin).
Wirth
T
T
Klinikum für Orthopädie des Klinikums der Philipps-Universität, Marburg, Germany. wirth@mailer.uni-marburg.de
Schneider
B
B
Misselwitz
F
F
Lomb
M
M
Tüylü
H
H
Egbring
R
R
Griss
P
P
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001182:Arthroscopy / Q000009:adverse effects*; D004334:Drug Administration Schedule; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D007279:Injections, Subcutaneous; D007719:Knee Joint / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011182:Postoperative Care; D011446:Prospective Studies; D013923:Thromboembolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D014463:Ultrasonography
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; C094240:reviparin