title: Mechanical calf compression and aspirin prophylaxis for total knee arthroplasty.
abstract: We used aspirin and mechanical calf pneumatic compression for thromboembolism prophylaxis in 856 consecutive primary and revision total knee arthroplasties. Regional anesthesia was used in 97% of the procedures. Duplex ultrasonography was performed before discharge. We advised patients with calf thrombi to continue aspirin and have repeat duplex scans in 7 to 10 days. Patients with popliteal or femoral thrombi were given low-molecular-weight heparin and warfarin for 6 weeks. Using this protocol, the 90-day mortality rate was 0.14%. There was one fatal myocardial infarction. Three patients developed symptomatic nonfatal pulmonary embolisms, two occurring early and one late. Deep vein thrombosis occurred in 56 patients (9.3%). Only nine patients (1.5%) had symptomatic thrombosis, with four ipsilateral calf and five ipsilateral proximal thrombi. The data confirm the efficacy of a multimodal protocol with calf mechanical prophylaxis for almost all patients undergoing primary or revision total knee arthroplasty.
  
  
  METHODS
  Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics, University of North Carolina at Chapel Hill, 27599-7055, USA. Paul_Lachiewicz@med.unc.edu
authors.forename: Paul F
authors.initials: PF
authors.lastname: Lachiewicz
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Soileau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D001241:Aspirin / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D005268:Femoral Vein; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices; D007866:Leg; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011152:Popliteal Vein; D011183:Postoperative Complications / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*; D015995:Prevalence; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin