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Venous thromboembolism after lower limb arthroplasty: is chemical prophylaxis still needed?

  • Original Article • HIP - ARTHROPLASTY
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Venous thromboembolism (VTE) is a significant complication of lower limb arthroplasty. The National Institute for Health and Care Excellence recommends routine use of chemical and mechanical prophylaxis to prevent VTE. Our high-volume, elective, arthroplasty unit adopted this guidance in 2008.


We examined our incidence of VTE before and after introduction of chemical thromboprophylaxis to determine whether the incidence of VTE reduced.


We retrospectively gathered data on 2 cohorts of patients—from January 2004 to August 2007 (Group 1) and January 2010 to December 2012 (Group 2). Patients in Group 1 received mechanical prophylaxis only (unless particularly high risk for VTE), and patients in Group 2 received mechanical and chemical prophylaxis. We recorded VTE occurring within 6 months of surgery. Patients in Group 1 receiving chemical prophylaxis were excluded.


Group 1 had 2320 cases of primary and revision lower limb arthroplasty, and Group 2 had 1430 cases. VTE occurred in 37 cases in Group 1 (1.6 %), and in 17 cases in Group 2 (1.2 %). This difference was not statistically significant (p = 0.26). In Group 1, 1 patient died within 6 months due to pulmonary embolism (0.04 %); there were no VTE-related deaths in Group 2 (0 %). This was also not statistically significant (p = 0.06).


Although our VTE rate reduced by 0.4 % and our VTE-related mortality reduced by 0.04 % after introduction of chemical thromboprophylaxis, these differences were not statistically significant. Chemical thromboprophylaxis may not be required in all patients undergoing arthroplasty providing appropriate mechanical prophylaxis is used.

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  1. Imperiale TF, Speroff T (1994) A meta-analysis of methods to prevent venous thromboembolism following total hip replacement. JAMA 271:1780–1785

    Article  CAS  PubMed  Google Scholar 

  2. Warwick D, Williams MH, Bannister GC (1995) Death and thromboembolic disease after total hip replacement. A series of 1162 cases with no routine chemical prophylaxis. J Bone Joint Surg Br 77:6–10

    CAS  PubMed  Google Scholar 

  3. Howie C, Hughes H, Watts AC (2005) Venous thromboembolism associated with hip and knee replacement over a ten-year period: a population-based study. J Bone Joint Surg Br 87:1675–1680. doi:10.1302/0301-620X.87B12.16298

    Article  CAS  PubMed  Google Scholar 

  4. Strebel N, Prins M, Agnelli G, Buller HR (2002) Preoperative or postoperative start of prophylaxis for venous thromboembolism with low-molecular-weight heparin in elective hip surgery? Arch Intern Med 162:1451–1456

    Article  CAS  PubMed  Google Scholar 

  5. NICE (2010) Venous thromboembolism: reducing the risk for patients in hospital. Accessed 20 Jan 2016

  6. Jameson SS, Bottle A, Malviya A, Muller SD, Reed MR (2010) The impact of national guidelines for the prophylaxis of venous thromboembolism on the complications of arthroplasty of the lower limb. J Bone Joint Surg Br 92:123–129. doi:10.1302/0301-620X.92B1.22751

    Article  CAS  PubMed  Google Scholar 

  7. Colwell CW Jr, Froimson MI, Mont MA, Ritter MA, Trousdale RT, Buehler KC, Spitzer A, Donaldson TK, Padgett DE (2010) Thrombosis prevention after total hip arthroplasty: a prospective, randomized trial comparing a mobile compression device with low-molecular-weight heparin. J Bone Joint Surg Am 92:527–535. doi:10.2106/JBJS.I.00047

    Article  PubMed  Google Scholar 

  8. Yokote R, Matsubara M, Hirasawa N, Hagio S, Ishii K, Takata C (2011) Is routine chemical thromboprophylaxis after total hip replacement really necessary in a Japanese population? J Bone Joint Surg Br 93:251–256. doi:10.1302/0301-620X.93B2.25795

    Article  CAS  PubMed  Google Scholar 

  9. Yassin M, Mitchell C, Diab M, Senior C (2014) The necessity of pharmacological prophylaxis against venous thromboembolism in major joint arthroplasty. Int Orthop 38:1073–1075. doi:10.1007/s00264-013-2233-6

    Article  PubMed  Google Scholar 

  10. Jorgensen CC, Jacobsen MK, Soeballe K, Hansen TB, Husted H, Kjaersgaard-Andersen P, Hansen LT, Laursen MB, Kehlet H (2013) Thromboprophylaxis only during hospitalisation in fast-track hip and knee arthroplasty, a prospective cohort study. BMJ Open 3:e003965. doi:10.1136/bmjopen-2013-003965

    Article  PubMed  PubMed Central  Google Scholar 

  11. Husted H, Otte KS, Kristensen BB, Orsnes T, Wong C, Kehlet H (2010) Low risk of thromboembolic complications after fast-track hip and knee arthroplasty. Acta Orthop 81:599–605. doi:10.3109/17453674.2010.525196

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kehlet H, Thienpont E (2013) Fast-track knee arthroplasty—status and future challenges. Knee 20(Suppl 1):S29–S33. doi:10.1016/S0968-0160(13)70006-1

    Article  PubMed  Google Scholar 

  13. Hu S, Zhang ZY, Hua YQ, Li J, Cai ZD (2009) A comparison of regional and general anaesthesia for total replacement of the hip or knee: a meta-analysis. J Bone Joint Surg Br 91:935–942. doi:10.1302/0301-620X.91B7.21538

    Article  CAS  PubMed  Google Scholar 

  14. Gomez-Outes A, Terleira-Fernandez AI, Suarez-Gea ML, Vargas-Castrillon E (2012) Dabigatran, rivaroxaban, or apixaban versus enoxaparin for thromboprophylaxis after total hip or knee replacement: systematic review, meta-analysis, and indirect treatment comparisons. BMJ 344:e3675. doi:10.1136/bmj.e3675

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hunt LP, Ben-Shlomo Y, Clark EM, Dieppe P, Judge A, MacGregor AJ, Tobias JH, Vernon K, Blom AW, National Joint Registry for E, Wales (2014) 45-Day mortality after 467,779 knee replacements for osteoarthritis from the National Joint Registry for England and Wales: an observational study. Lancet 384:1429–1436. doi:10.1016/S0140-6736(14)60540-7

    Article  PubMed  Google Scholar 

  16. Hunt LP, Ben-Shlomo Y, Clark EM, Dieppe P, Judge A, MacGregor AJ, Tobias JH, Vernon K, Blom AW, National Joint Registry for England W, Northern I (2013) 90-Day mortality after 409,096 total hip replacements for osteoarthritis, from the National Joint Registry for England and Wales: a retrospective analysis. Lancet 382:1097–1104. doi:10.1016/S0140-6736(13)61749-3

    Article  PubMed  Google Scholar 

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Correspondence to Karan Malhotra.

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The protocol for this retrospective study was reviewed and approved by our local institutional review board. This project was initiated as an audit as part of service evaluation, and therefore it was deemed that ethical approval was not required. Individual patient data are not reported, and therefore consent was not required. This article does not contain any studies with human participants or animals performed by any of the authors.

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Malhotra, K., Marciniak, J.L., Bonczek, S.J. et al. Venous thromboembolism after lower limb arthroplasty: is chemical prophylaxis still needed?. Eur J Orthop Surg Traumatol 26, 895–899 (2016).

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