title: Thromboprophylaxis only during hospitalisation in fast-track hip and knee arthroplasty, a prospective cohort study.
abstract: OBJECTIVE
  International guidelines recommend thrombosis prophylaxis after total hip arthroplasty (THA) and total knee arthroplasty (TKA) for up to 35 days. However, previous studies often have hospital stays (length of stay; LOS) of 8-12 days and not considering early mobilisation, which may reduce incidence of venous thromboembolic events (VTE). We investigated the incidence of any symptomatic thromboembolic events (TEEs) with only in-hospital prophylaxis if LOS ≤5 days after fast-track THA and TKA.
  
  
  METHODS
  A prospective descriptive multicentre cohort study in fast-track THA and TKA from February 2010 to December 2011, with complete 90-day follow-up through the Danish National Patient Registry and patient files.
  
  
  METHODS
  6 Danish high-volume centres with a similar standardised fast-track setup, including spinal anaesthesia, opioid-sparing analgesia, early mobilisation, functional discharge criteria and discharge to own home.
  
  
  METHODS
  4924 consecutive unselected unilateral primary THA and TKAs in patients ≥18 years with no preoperative use of continuous 'potent' anticoagulative therapy (vitamin K antagonists).
  
  
  METHODS
  Prophylaxis with low-molecular-weight heparin or factor Xa-inhibitors only during hospitalisation when LOS ≤5 days.
  
  
  RESULTS
  Incidence of symptomatic TEE-related, VTE-related and VTE-related mortality ≤90 days postoperatively.
  
  
  RESULTS
  LOS ≤5 days and thromboprophylaxis only during hospitalisation occurred in 4659 procedures (94.6% of total). Median LOS and prophylaxis duration was 2 days (IQR 2-3) with 0.84% (95% CI 0.62% to 1.15%) TEE and 0.41% (0.26% to 0.64%) VTE during 90-day follow-up. VTE consisted of five pulmonary embolisms (0.11% (0.05% to 0.25%)) and 14 deep venous thrombosis (0.30% (0.18% to 0.50%)). There were four (0.09% (0.04% to 0.23%)) surgery-related deaths, of which 1 (0.02% (0.00% to 0.12%)) was due to pulmonary embolism, and 6 (0.13% (0.06% to 0.28%)) deaths of unknown causes after discharge.
  
  
  CONCLUSIONS
  The low incidence of TEE and VTE suggests that in-hospital prophylaxis only, is safe in fast-track THA and TKA patients with LOS of ≤5 days. Guidelines on thromboprophylaxis may need reconsideration in fast-track elective surgery.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT01557725.
authors: Section for Surgical Pathophysiology, The Juliane Marie Centre, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
authors: Christoffer C
authors: CC
authors: Jørgensen
authors: Michael K
authors: MK
authors: Jacobsen
authors: Kjeld
authors: K
authors: Soeballe
authors: Torben B
authors: TB
authors: Hansen
authors: Henrik
authors: H
authors: Husted
authors: Per
authors: P
authors: Kjærsgaard-Andersen
authors: Lars T
authors: LT
authors: Hansen
authors: Mogens B
authors: MB
authors: Laursen
authors: Henrik
authors: H
authors: Kehlet