Natural Course of Asymptomatic Deep Venous Thrombosis in Hip Surgery without Pharmacologic Thromboprophylaxis in an Asian Population
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The clinical importance of asymptomatic deep venous thrombosis in elective hip surgery is not clearly known.
We determined the preoperative and postoperative incidences of asymptomatic deep venous thrombosis, identified preoperative factors associated with postoperative deep venous thrombosis or pulmonary embolism, and established its natural course in patients who underwent elective hip surgery without receiving pharmacologic thromboprophylaxis.
Patients and Methods
We reviewed 184 patients who underwent consecutive elective hip surgeries with a mechanical thromboprophylaxis regimen including combined general and epidural anesthesia, intraoperative calf bandaging, early mobilization, and postoperative intermittent pneumatic compression with additional use of elastic stockings. Duplex ultrasonography was performed routinely to diagnose deep venous thrombosis in all patients before surgery and on Postoperative Days 3 and 21. All patients with postoperative deep venous thrombosis underwent additional ultrasonography at 3-month intervals, and all patients were followed postoperatively for 6 months or more.
Preoperatively, we found asymptomatic deep venous thrombosis in two patients (1%); both thromboses had completely and spontaneously resolved by Postoperative Day 21. Postoperatively, no patients had a fatal or symptomatic pulmonary embolism or proximal deep venous thrombosis, but nine patients (5%) had asymptomatic distal deep venous thrombosis develop, with no preoperative associated factors. These nine patients were followed closely without anticoagulant drugs, and all thromboses had disappeared without pulmonary embolism or thrombophlebitis by 6 months.
The incidence of preoperative and postoperative deep venous thrombosis was low in an Asian population having elective hip surgery and a nonpharmacologic thromboprophylaxis regimen. There were no preoperative factors associated with postoperative deep venous thrombosis, and all asymptomatic deep venous thromboses resolved spontaneously without associated pulmonary embolism or thrombophlebitis.
Level of Evidence
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
- Allsup, DJ (1994) Use of the intermittent pneumatic compression device in venous ulcer disease. J Vasc Nurs. 12: pp. 106-111
- Atri, M, Herba, MJ, Reinhold, C, Leclerc, J, Ye, S, Illescas, FF, Bret, PM (1996) Accuracy of sonography in the evaluation of calf deep vein thrombosis in both postoperative surveillance and symptomatic patients. AJR Am J Roentgenol. 166: pp. 1361-1367
- Doouss, TW (1976) The clinical significance of venous thrombosis of the calf. Br J Surg. 63: pp. 377-378 CrossRef
- Dorr, LD, Gendelman, V, Maheshwari, AV, Boutary, M, Wan, Z, Long, WT (2007) Multimodal thromboprophylaxis for total hip and knee arthroplasty based on risk assessment. J Bone Joint Surg Am. 89: pp. 2648-2657 CrossRef
- Eikelboom, JW, Karthikeyan, G, Fagel, N, Hirsh, J (2009) American Association of Orthopaedic Surgeons and American College of Chest Physicians guidelines for venous thromboembolism prevention in hip and knee arthroplasty differ: what are the implications for clinicians and patients?. Chest. 135: pp. 513-520 CrossRef
- Fordyce, MJ, Ling, RS (1992) A venous foot pump reduces thrombosis after total hip replacement. J Bone Joint Surg Br. 74: pp. 45-49
- Fujita, S, Hirota, S, Oda, T, Kato, Y, Tsukamoto, Y, Fuji, T (2000) Deep venous thrombosis after total hip or total knee arthroplasty in patients in Japan. Clin Orthop Relat Res. 375: pp. 168-174 CrossRef
- Geerts, WH, Bergqvist, D, Pineo, GF, Heit, JA, Samama, CM, Lassen, MR, Colwell, CW (2008) American College of Chest Physicians. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133: pp. 381S-453S CrossRef
- Giachino, A (1988) Relationship between deep-vein thrombosis in the calf and fatal pulmonary embolism. Can J Surg. 31: pp. 129-130
- Grady-Benson, JC, Oishi, CS, Hanson, PB, Colwell, CW, Otis, SM, Walker, RH (1994) Postoperative surveillance for deep venous thrombosis with duplex ultrasonography after total knee arthroplasty. J Bone Joint Surg Am. 76: pp. 1649-1657
- Habscheid, W, Wilhelm, T (1988) [Diagnosis of deep vein thromboses by real-time sonography] [in German]. Dtsch Med Wochenshr. 113: pp. 586-591 CrossRef
- Hooker, JA, Lachiewicz, PF, Kelley, SS (1999) Efficacy of prophylaxis against thromboembolism with intermittent pneumatic compression after primary and revision total hip arthroplasty. J Bone Joint Surg Am. 81: pp. 690-696
- Johanson, NA, Lachiewicz, PF, Lieberman, JR, Lotke, PA, Parvizi, J, Pellegrini, V, Stringer, TA, Tornetta, P, Haralson, RH, Watters, WC (2009) American Academy of Orthopaedic Surgeons clinical practice guideline on prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty. J Bone Joint Surg Am. 91: pp. 1756-1757 CrossRef
- Kakkar, VV, Howe, CT, Flanc, C, Clark, MB (1969) Natural history of postoperative deep vein thrombosis. Lancet. 2: pp. 230-232 CrossRef
- Kearon, C, Ginsberg, JS, Hirsh, J (1998) The role of venous ultrasonography in the diagnosis of suspected deep venous thrombosis and pulmonary embolism. Ann Intern Med. 129: pp. 1044-1049
- Kim, YH, Oh, SH, Kim, JS (2003) Incidence and natural history of deep-vein thrombosis after total hip arthroplasty: a prospective and randomised clinical study. J Bone Joint Surg Br. 85: pp. 661-665 CrossRef
- Kim, YH, Suh, JS (1988) Low incidence of deep-vein thrombosis after cementless total hip replacement. J Bone Joint Surg Am. 70: pp. 878-882
- Kraay, MJ, Goldberg, VM, Herbener, TE (1993) Vascular ultrasonography for deep venous thrombosis after total knee arthroplasty. Clin Orthop Relat Res. 286: pp. 18-26
- Lachiewicz, PF, Soileau, ES (2006) Multimodal prophylaxis for THA with mechanical compression. Clin Orthop Relat Res. 453: pp. 225-230 CrossRef
- Lieberman, JR, Geerts, WH (1994) Prevention of venous thromboembolism after total hip and knee arthroplasty. J Bone Joint Surg Am. 76: pp. 1239-1250
- Lotke, PA, Steinberg, ME, Ecker, ML (1994) Significance of deep venous thrombosis in the lower extremity after total joint arthroplasty. Clin Orthop Relat Res. 299: pp. 25-30
- Moser, KM, LeMoine, JR (1981) Is embolic risk conditioned by location of deep venous thrombosis?. Ann Intern Med. 94: pp. 439-444
- National Institute for Health and Clinical Excellence. Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients undergoing surgery. NICE Clinical Guideline 2007. Available at: http://www.nice.org.uk/CG046fullguideline. Accessed November 11, 2009.
- Pellegrini, VD, Langhans, MJ, Totterman, S, Marder, VJ, Francis, CW (1993) Embolic complications of calf thrombosis following total hip arthroplasty. J Arthroplasty. 8: pp. 449-457 CrossRef
- Piovella, F, Wang, CJ, Lu, H, Lee, K, Lee, LH, Lee, WC, Turpie, AG, Gallus, AS, Planès, A, Passera, R, Rouillon, A (2005) Deep-vein thrombosis rates after major orthopedic surgery in Asia: an epidemiological study based on postoperative screening with centrally adjudicated bilateral venography. J Thromb Haemost. 3: pp. 2664-2670 CrossRef
- Pitto, RP, Hamer, H, Heiss-Dunlop, W, Kuehle, J (2004) Mechanical prophylaxis of deep-vein thrombosis after total hip replacement: a randomised clinical trial. J Bone Joint Surg Br. 86: pp. 639-642 CrossRef
- Robinson, KS, Anderson, DR, Gross, M, Petrie, D, Leighton, R, Stanish, W, Alexander, D, Mitchell, M, Mason, W, Flemming, B, Fairhurst-Vaughan, M, Gent, M (1998) Accuracy of screening compression ultrasonography and clinical examination for the diagnosis of deep vein thrombosis after total hip or knee arthroplasty. Can J Surg. 41: pp. 368-373
- Ryan, MG, Westrich, GH, Potter, HG, Sharrock, N, Maun, LM, Macaulay, W, Katkin, P, Sculco, TP, Salvati, EA (2002) Effect of mechanical compression on the prevalence of proximal deep venous thrombosis as assessed by magnetic resonance venography. J Bone Joint Surg Am. 84: pp. 1998-2004
- Salvati, EA, Sharrock, NE, Westrich, G, Potter, HG, Valle, AG, Sculco, TP (2007) The 2007 ABJS Nicolas Andry Award. Three decades of clinical, basic, and applied research on thromboembolic disease after THA: rationale and clinical results of a multimodal prophylaxis protocol. Clin Orthop Relat Res. 459: pp. 246-254 CrossRef
- Siddiqui, AU, Buchman, TG, Hotchkiss, RS (2000) Pulmonary embolism as a consequence of applying sequential compression device on legs in a patient asymptomatic of deep vein thrombosis. Anesthesiology. 92: pp. 880-882 CrossRef
- Sugano, N, Miki, H, Nakamura, N, Aihara, M, Yamamoto, K, Ohzono, K (2009) Clinical efficacy of mechanical thromboprophylaxis without anticoagulant drugs for elective hip surgery in an Asian population. J Arthroplasty. 24: pp. 1254-1257 CrossRef
- The Guideline Committee of the Japanese Orthopaedic Association for Prevention of Venous Thromboembolism. [The Guidelines for Prevention of Venous Thromboembolism] [in Japanese]. Tokyo, Japan: Nankodo; 2008.
- Warwick, D, Harrison, J, Glew, D, Mitchelmore, A, Peters, TJ, Donovan, J (1998) Comparison of the use of a foot pump with the use of low-molecular-weight heparin for the prevention of deep-vein thrombosis after total hip replacement: a prospective, randomized trial. J Bone Joint Surg Am. 80: pp. 1158-1166
- Woolson, ST (1996) Intermittent pneumatic compression prophylaxis for proximal deep venous thrombosis after total hip replacement. J Bone Joint Surg Am. 78: pp. 1735-1740
- Natural Course of Asymptomatic Deep Venous Thrombosis in Hip Surgery without Pharmacologic Thromboprophylaxis in an Asian Population
Clinical Orthopaedics and Related Research®
Volume 468, Issue 9 , pp 2430-2436
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- 1. Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- 2. Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- 3. Center of Arthroplasty, Kyowakai Hospital, Suita, Osaka, Japan
- 4. Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan