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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 6, 799-807.
doi: 10.1302/0301-620X.89B6.18844  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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Insufficient duration of venous thromboembolism prophylaxis after total hip or knee replacement when compared with the time course of thromboembolic events

FINDINGS FROM THE GLOBAL ORTHOPAEDIC REGISTRY

D. Warwick, MD, FRCS, FRCS(Orth), Consultant Orthopaedic Surgeon1; R. J. Friedman, MD, FRCS(C), Orthopaedic Surgeon2; G. Agnelli, MD, Professor of Internal Medicine3; E. Gil-Garay, MD, Orthopaedic Surgeon4; K. Johnson, MD, Orthopaedic Surgeon5; G. FitzGerald, MD, Biostatistician6; and F. M. Turibio, MD, Orthopaedic Surgeon7

1 University of Southampton, Southampton, Hampshire SO16 6UY, UK.
2 Charleston Orthopaedic Associates, 2270 Ashley Crossing Drive, Suite 110, Charleston, South Carolina 29414, USA.
3 Department of Internal Medicine, Division of Internal and Vascular Medicine, Stroke Unit University of Perugia, 06123 Perugia, Italy.
4 Hospital Universitario La Paz, Madrid 28036, Spain.
5 University of Massachusetts Memorial Health Care, 33 Oak Avenue, Worcester, Massachusetts 01605, USA.
6 Center for Outcomes Research University of Massachusetts Medical School, 365 Plantation Street, Suite 185, Worcester, Massachussets 01605, USA.
7 Hospital Santa Marcelina, Rua Cantagalo 447, São Paulo, SP 03319-000, Brazil.

Correspondence should be sent to Mr D. Warwick; e-mail: djwarwick{at}compuserve.com

Patients who have undergone total hip or knee replacement (THR and TKR, respectively) are at high risk of venous thromboembolism. We aimed to determine the time courses of both the incidence of venous thromboembolism and effective prophylaxis. Patients with elective primary THR and TKR were enrolled in the multi-national Global Orthopaedic Registry. Data on the incidence of venous thromboembolism and prophylaxis were collected from 6639 THR and 8326 TKR patients.

The cumulative incidence of venous thromboembolism within three months of surgery was 1.7% in the THR and 2.3% in the TKR patients. The mean times to venous thromboembolism were 21.5 days (SD 22.5) for THR, and 9.7 days (SD 14.1) for TKR. It occurred after the median time to discharge in 75% of the THR and 57% of the TKA patients who developed venous thromboembolism. Of those who received recommended forms of prophylaxis, approximately one-quarter (26% of THR and 27% of TKR patients) were not receiving it seven days after surgery, the minimum duration recommended at the time of the study.

The risk of venous thromboembolism extends beyond the usual period of hospitalisation, while the duration of prophylaxis is often shorter than this. Practices should be re-assessed to ensure that patients receive appropriate durations of prophylaxis.




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eLetters:

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Insufficient duration of venous thromboembolism prophylaxis after total hip or knee replacement
Benedict A Rogers
J Bone Joint Surg Br Online, 1 Aug 2007 [Full text]
No evidence for prolonged use of anticoagulants after THR and TKR
Martin A McNally
J Bone Joint Surg Br Online, 24 Aug 2007 [Full text]
Author's reply:
David Warwick, et al.
J Bone Joint Surg Br Online, 10 Sep 2007 [Full text]

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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General