Prevention of deep-vein thrombosis after total knee arthroplasty in Asian patients. Comparison of low-molecular-weight heparin and indomethacin.
BACKGROUND
A prospective clinical study was performed to compare the efficacy of low-molecular-weight heparin and indomethacin for the prevention of deep-vein thrombosis after total knee arthroplasty in Asian patients.


METHODS
One hundred and fifty patients undergoing total knee arthroplasty were randomly divided into three groups. One group consisted of fifty-one patients who received no prophylaxis with an anticoagulant (the control group), one consisted of fifty patients who received the low-molecular-weight heparin Fraxiparine (the Fraxiparine group), and the third consisted of forty-nine patients who received indomethacin (the indomethacin group). Bilateral ascending venography was performed preoperatively and at five, six, or seven days postoperatively. A third venogram was made at three months for patients who had had a deep-vein thrombosis.


RESULTS
The prevalence of deep-vein thrombosis was 71% in the control group, 50% in the Fraxiparine group (p = 0.042), and 45% in the indomethacin group (p = 0.011). Only 28% of the deep-vein thromboses were symptomatic, and there were no pulmonary emboli.


CONCLUSIONS
Compared with no prophylaxis, Fraxiparine and indomethacin significantly lowered the prevalence of deep-vein thrombosis after total knee arthroplasty. Prophylaxis against deep-vein thrombosis in the Asian population appears to be warranted.


METHODS
Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.
Wang
Ching-Jen
CJ
Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan. w281211@adm.cgmh.org.tw
Wang
Jun-Wen
JW
Weng
Lin-Hsiu
LH
Hsu
Chia-Chen
CC
Huang
Chung-Cheng
CC
Yu
Pao-Chu
PC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D000925:Anticoagulants / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D017762:Nadroparin / Q000008:administration & dosage*; D010690:Phlebography; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013624:Taiwan; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D017762:Nadroparin; D007213:Indomethacin