title: Safety of a clinical surveillance protocol with 3- and 6-week warfarin prophylaxis after total joint arthroplasty.
abstract: The charts of 1869 patients were reviewed for the occurrence of deep venous thrombosis (DVT) and pulmonary embolism after total hip or knee arthroplasty. Prophylaxis consisted of 3 (group 1; n=1235) or 6 (group 2; n=634) weeks low-dose warfarin, pneumatic compression boots worn by patients in the hospital, mobilization on the first postoperative day, and a clinical surveillance protocol. Venous ultrasound or ventilation/perfusion lung scintigraphy (V/Q) was performed only if patients became symptomatic. patients. Twenty-three (1.8%) patients were positive for DVT. Ventilation/perfusion lung scintigraphy was performed on 25 patients, and 5 (0.4%) patients were positive for pulmonary embolism. In group 2, 117 patients were evaluated for DVT, and 19 (3%) patients had positive results determined by ultrasound. Twenty-five patients were evaluated with V/Q and only 1 (0.16%) patient was positive for pulmonary embolism. No patient developed a fatal pulmonary embolism or postphlebitic syndrome. This prophylaxis protocol is an efficient and cost-effective method for the prevention of significant events after surgery.
authors.affiliation: Illinois Bone and Joint Institute, Desplaines 60016, USA.
authors.forename: W M
authors.initials: WM
authors.lastname: Goldstein
authors.forename: M L
authors.initials: ML
authors.lastname: Jimenez
authors.forename: D S
authors.initials: DS
authors.lastname: Bailie
authors.forename: R
authors.initials: R
authors.lastname: Wall
authors.forename: J
authors.initials: J
authors.lastname: Branson
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001458:Bandages; D002985:Clinical Protocols / Q000592:standards; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000191:economics / Q000379:methods* / Q000592:standards; D004434:Early Ambulation; D005260:Female; D006801:Humans; D008297:Male; D011182:Postoperative Care / Q000191:economics / Q000379:methods* / Q000592:standards; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D012449:Safety; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D014692:Ventilation-Perfusion Ratio; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin