title: Routine duplex ultrasound screening after TKA is not necessary.
abstract: We determined if negative ultrasound screening at the time of acute care hospital discharge or 2 weeks post operatively would reliably identify patients without deep venous thrombosis, thus allowing discontinuation of warfarin chemoprophylaxis. Patients undergoing primary TKA (1344) were treated with adjusted-dose warfarin (target prothrombin time, 15-18 seconds; internationalized normalization ratio, 1.4-1.7) until screening and then aspirin (325 mg po bid) until 6 weeks postoperatively. Deep venous thrombosis as determined by ultrasound was the measured outcome. From 1994 to 1997, 525 patients underwent screening ultrasound before discharge (usually postoperative Day 3): 12 (2.3%) patients with proximal deep venous thrombosis and three (0.6%) patients with distal deep venous thrombosis were identified. From 1997 to 2001, 819 patients underwent ultrasound screening at Day 14 postoperatively: 10 (1.2%) patients with proximal deep venous thrombosis and 29 (3.6%) patients with distal deep venous thromboses were identified. There was no difference in proximal deep venous thrombosis detection, but there was a difference in distal deep venous thrombosis detection. We no longer screen asymptomatic patients with ultrasound for deep venous thrombosis after TKA.
authors.affiliation: Department of Orthopaedic Surgery, Lahey Clinic Medical Center, Burlington, MA 01805, USA. richardiorio@lahey.org
authors.forename: Richard
authors.initials: R
authors.lastname: Iorio
authors.forename: Scott
authors.initials: S
authors.lastname: Dhupar
authors.forename: William L
authors.initials: WL
authors.lastname: Healy
authors.forename: Eric
authors.initials: E
authors.lastname: Wong
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D006801:Humans; D011446:Prospective Studies; D018616:Ultrasonography, Doppler, Duplex; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin