title: Thromboembolism Prophylaxis in Hip Arthroplasty: Routine and High Risk Patients.
abstract: This study's purpose was to present the use of a risk stratification protocol in which "routine" risk patients receive a mobile compression device with aspirin and "high" risk patients receive warfarin for thromboprophylaxis after hip arthroplasty. 1859 hip arthroplasty patients were prospectively enrolled (1402 routine risk--75.4%, 457 high risk--24.6%). The cumulative rate of venous thromboembolism events was 0.5% in the routine versus 0.5% in the high-risk cohort within 6weeks postoperatively (P=1.00). Patients in the routine risk cohort had a lower rate of major bleeding (0.5% versus 2.0%, P=0.006) and wound complications (0.2% versus 1.2%, P=0.01). Use of our risk stratification protocol allowed the avoidance of more aggressive anticoagulation in 75% of patients while achieving a low overall incidence of symptomatic VTE.
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Denis
authors.initials: D
authors.lastname: Nam
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Nunley
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Staci R
authors.initials: SR
authors.lastname: Johnson
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: James A
authors.initials: JA
authors.lastname: Keeney
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: John C
authors.initials: JC
authors.lastname: Clohisy
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Barrack
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001241:Aspirin / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D048228:Intermittent Pneumatic Compression Devices; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D011184:Postoperative Period; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D001241:Aspirin
keywords: bleeding; deep venous thrombosis; hip arthroplasty; pulmonary embolism; thromboprophylaxis