title: Staged venous thromboemolic events prophylaxis with low-molecular-weight heparin followed by aspirin is safe and effective after arthroplasty.
abstract: BACKGROUND
  The rate of fatal pulmonary embolism (PE) following hip and knee arthroplasty has remained unchanged despite the use of low-molecular-weight heparin (LMWH) and oral antithrombotic agents. Concerns regarding bleeding and wound complications resulted in the introduction of a staged chemoprophylaxis protocol at our institution in 2002. We hypothesized that staged chemoprophylaxis using LMWH in hospital followed by aspirin after discharge was safe and effective for the prevention of venous thromboembolic events (VTE).
  
  
  METHODS
  Data were retrospectively collected on all patients undergoing hip and knee arthroplasty between 2002 and 2012. For VTE prophylaxis, LMWH was administered to all patients following surgery until discharge. Aspirin was prescribed from discharge until 6 weeks following surgery. Complications were recorded in a database. Patients suspected of having a VTE were investigated with bilateral lower limb duplex ultrasound and computerized tomography-pulmonary angiogram.
  
  
  RESULTS
  The 11-year results of this protocol used in 9035 patients with a mean age 62 years (range 20-95) and follow-up at 6 weeks demonstrate an overall symptomatic VTE rate of 2.55% and overall PE rate of 1.28%. The overall fatal PE rate is 0.03% (unicompartmental knee arthroplasty 0.07-0.96%, total knee arthroplasty 0.19% and total hip arthroplasty 0%) and the all-cause mortality is 0.07%. The wound complication rate is low.
  
  
  CONCLUSIONS
  Staged chemoprophylaxis using LMWH followed by aspirin is a safe and effective thromboprophylactic regime that is associated with a very low rate of fatal PE and all-cause mortality.
authors.affiliation: Orthopaedic Surgery, Sportsmed.SA, Adelaide, South Australia, Australia.
authors.forename: Vipin
authors.initials: V
authors.lastname: Asopa
authors.affiliation: Medical, Sportsmed.SA, Adelaide, South Australia, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Cobain
authors.affiliation: Orthopaedic Surgery, Sportsmed.SA, Adelaide, South Australia, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Martin
authors.affiliation: Orthopaedic Surgery, Sportsmed.SA, Adelaide, South Australia, Australia.
authors.forename: Greg
authors.initials: G
authors.lastname: Keene
authors.affiliation: Orthopaedic Surgery, Sportsmed.SA, Adelaide, South Australia, Australia.
authors.forename: Adrian
authors.initials: A
authors.lastname: Bauze
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001241:Aspirin / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013021:South Australia / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D001241:Aspirin
keywords: DVT; arthroplasty; complications; prophylaxis; venous thromboembolism