Skip to main content
SpringerLink
Log in

The Postdischarge Risk of Venous Thromboembolism after Hip Replacement

The Role of Prolonged Prophylaxis

  • Published:
Drugs Aims and scope Submit manuscript

Summary

This review deals with the problems of delayed thrombosis after hip arthroplasty and the possible need for prolonged prophylaxis. These problems have been considered key questions in the European Consensus Statement on venous thromboembolism. There are several factors, such as long immobilisation, venous trauma and decreased venous emptying, which all may contribute to the development of late postoperative thrombosis. There are data on frequencies of venous thromboembolism supporting the occurrence of such late complications. In 4 recent studies on prolonged prophylaxis, it was consistently shown that prophylaxis with low molecular weight heparins for 1 month significantly reduced the frequency of deep venous thrombosis compared with conventional prophylaxis during hospitalisation in patients undergoing elective hip arthroplasty.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Stamatakis JD, Kakkar VV, Sagar S, et al. Femoral vein thrombosis and total hip replacement. BMJ 1997; 2: 223–5

    Article  Google Scholar 

  2. Johnson R, Carmichael J, Almoud H. Deep venous thrombosis following Charnley arthroplasty. Clin Orthop 1978; 132: 24–30

    PubMed  Google Scholar 

  3. Planes A, Vochelle N, Fagola M. Total hip replacement and deep vein thrombosis: a venographic and necropsy study. J Bone Joint Surg 1990; 72B: 9–13

    Google Scholar 

  4. Lassen MR, Borris LC, Christiansen HM, et al. Prevention of thromboembolism in 190 hip arthroplasties. Comparison of LMW heparin and placebo. Acta Orthop Scand 1991; 62: 33–8

    Article  PubMed  CAS  Google Scholar 

  5. Kälebo P, Anthmyr BA, Eriksson BI, et al. Phlebographic findings in venous thrombosis following total hip replacement. Acta Radiol 1990; 31: 259–63

    PubMed  Google Scholar 

  6. Modig J. Studies on the aetiology and nature of the pulmonary and circulatory reactions during total hip replacement. Acta Univers Upsal 1975: thesis no. 223: 1-79

  7. Francis CW, Marder V, Evarts CM. Lower risk of thromboem-bolic disease after total hip replacement with non-cemented than with cemented prosthesis. Lancet 1986; I: 769

    Article  Google Scholar 

  8. Bredbacka S, Andreen M, Blombäck M, et al. Activation of cascade systems by hip arthroplasty. No difference between fixation with and without cement. Acta Orthop Scand 1987; 58: 231–5

    Article  PubMed  CAS  Google Scholar 

  9. McNally MA, Mollan RAB. Total hip replacement, lower limb blood flow and venous thrombogenesis. J Bone Joint Surg 1993; 75B: 640–4

    Google Scholar 

  10. Comerota A, Stewart GJ, Alburger PD, et al. Operative venodilation: a previously unsuspected factor in the course of postoperative deep vein thrombosis. Surgery 1989; 106: 301–9

    PubMed  CAS  Google Scholar 

  11. Sevitt S, Gallagher NG. Prevention of venous thrombosis and pulmonary embolism in injured patients. Lancet 1959; II: 981

    Article  Google Scholar 

  12. Bergqvist D, Lindblad B. A 30-year survey of pulmonary embolism verified at autopsy: an analysis of 1274 surgical patients. Br J Surg 1985; 72: 105–8

    Article  PubMed  CAS  Google Scholar 

  13. Lindblad B, Eriksson MS, Bergqvist D. Autopsy verified pulmonary embolism at a surgical department. An analysis of the period 1951-1988. Br J Surg 1991; 78: 849–52

    Article  PubMed  CAS  Google Scholar 

  14. Bergqvist D, Fredin H. Pulmonary embolism and mortality in patients with fractured hips — a prospective consecutive series. Eur J Surg 1991; 157: 571–4

    PubMed  CAS  Google Scholar 

  15. Huber O, Bounameaux H, Borst F, et al. Postoperative pulmonary embolism after hospital discharge. Arch Surg 1992; 127: 310–3

    Article  PubMed  CAS  Google Scholar 

  16. Schrøder H, Andreassen M. Autopsy-verified major pulmonary embolism after hip fracture. Clin Orthop Rel Res 1993; 293: 196–203

    Google Scholar 

  17. Nicolaides AN, Gordon-Smith I. A rational approach to prevention. In: Nicolaides AW, editor. Thromboembolism. Aetiology, advances in prevention and management. Lancaster: MTP, 1975: 205–25

    Google Scholar 

  18. Kakkar VV, Howe CT, Flanc C, et al. Natural history of postoperative deep-vein thrombosis. Lancet 1969; II: 230–3

    Article  Google Scholar 

  19. Schaub N, Duckert F, Fridrich R, et al. Häufigkeit postoperativer tiefer Venenthrombosen bei Patienten der Allgemeinen Chirurgie und Urologie Eine Untersuchung mit dem 125J-Fibrinogentest bei 95 Patienten ohne medikamentose Prophylaxe. Langenbecks Arch Chir 1975; 340: 23–34

    Article  PubMed  CAS  Google Scholar 

  20. Bergqvist D. Review of clinical trials of low molecular weight heparins. Eur J Surg 1992; 158: 67–78

    PubMed  CAS  Google Scholar 

  21. Kakkar VV, Cohen AT, Edmonson RA, et al. Low molecular weight heparin versus standard heparin for prevention of venous thromboembolism after major abdominal surgery. Lancet 1993; 341: 259–65

    Article  PubMed  CAS  Google Scholar 

  22. Hampson WG, Harris FC, Lucas HK, et al. Failure of low-dose heparin to prevent deep-vein thrombosis after hip replacement arthroplasty. Lancet 1974; II: 795–7

    Article  Google Scholar 

  23. Mannucci PM, Citerio LE, Panajotopoulos N. Low-dose heparin and deep-vein thrombosis after total hip replacement. Thromb Haemost 1976; 36: 157–64

    PubMed  CAS  Google Scholar 

  24. Bergqvist D, Elvelin R, Eriksson U, et al. Thrombosis following hip arthroplasty. A study using phlebography and 125I-fibrin-ogen test. Acta Orthop Scand 1976; 47: 549–57

    Article  PubMed  CAS  Google Scholar 

  25. Sikorski JM, Hampson WG, Staddon GE. The natural history and aetiology of deep vein thrombosis after hip replacement. J Bone Joint Surg 1981; 63B: 171

    Google Scholar 

  26. Johnson R, Green JR, Charnley J. Pulmonary embolism and its prophylaxis following the Charnley total hip replacement. Clin Orthop 1977; 127: 123–32

    PubMed  Google Scholar 

  27. Bergqvist D, Arnadottir M, Bergentz S-E, et al. Juvenile diabetes mellitus as a risk factor for postoperative venous thromboembolism. Acta Med Scand 1985; 217: 307–8

    Article  PubMed  CAS  Google Scholar 

  28. Scurr JH, Coleridge-Smith PD, Hasty JH. Regimen for improved effectiveness of intermittent pneumatic compression in deep venous thrombosis prophylaxis. Surgery 1987; 102: 816–20

    PubMed  CAS  Google Scholar 

  29. Sørensen C, Andersen M, Kristiansen V, et al. Development of late thromboembolic complications after major elective abdominal surgery: an interim report. Thromb Haemost 1989; 62: 129

    Google Scholar 

  30. Trowbridge A, Boese CK, Woodruff B, et al. Incidence of posthospitalization proximal deep venous thrombosis after total hip arthroplasty. Clin Orthopaed 1994; 299: 203–8

    Google Scholar 

  31. Tremaine JD, Choroszky CH, Menking SA. Deep vein thrombosis in total hip arthroplasty patients. J Vasc Technol 1992; 16: 23–7

    Google Scholar 

  32. Lotke PA, Steinberg ME, Malcolm L, et al. Significance of deep venous thrombosis in the lower extremity after total joint arthroplasty. Clin Orthopaed 1994; 299: 25–30

    Google Scholar 

  33. Nicolaides A, Arcelus J, Belcaro G, et al. Prevention of venous thromboembolism. European Consensus Statement. Int Angiol 1992; 11: 151–9

    PubMed  CAS  Google Scholar 

  34. Leizorovicz A, Haugh MC, Chapuis F-R, et al. Low molecular weight heparin in prevention of perioperative thrombosis. BMJ 1992; 305: 913–20

    Article  PubMed  CAS  Google Scholar 

  35. Nurmohamed M, Rosendal F, Biiller H, et al. Low molecular weight heparin versus standard heparin in general and orthopedic surgery. A meta-analysis. Lancet 1992; 340: 152–6

    Article  PubMed  CAS  Google Scholar 

  36. Mohr DN, Silverstein MD, Murtaugh PA, et al. Prophylactic agents for venous thrombosis in elective hip surgery. Arch Intern Med 1993; 153: 2221–8

    Article  PubMed  CAS  Google Scholar 

  37. Jørgensen LN, Wille-Jørgensen P, Hauch O. Prophylaxis of postoperative thromboembolism with low molecular weight heparins. Br J Surg 1993; 80: 689–704

    Article  PubMed  Google Scholar 

  38. Planes A, Vochelle N, Mazs F, et al. Prevention of postoperative venous thrombosis: a randomized trial comparing unfractionated heparin with low molecular weight heparin in patients undergoing total hip replacement. Thromb Haemost 1988; 60: 407–10

    PubMed  CAS  Google Scholar 

  39. Leyvraz PF, Bachmann F, Hoek J, et al. Prevention of deep vein thrombosis after hip replacement: randomised comparison between unfractionated heparin and low molecular weight heparin. BMJ 1991; 303: 543–8

    Article  PubMed  CAS  Google Scholar 

  40. Eriksson BI, Zachrisson BE, Teger-Nilsson AC, et al. Thrombosis prophylaxis with low molecular weight heparin in total hip replacement. Br J Surg 1988; 75: 1053–7

    Article  PubMed  CAS  Google Scholar 

  41. Bergqvist D, Benoni G, Björgell O, et al. Low-molecular weight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement. N Engl J Med 1996; 335: 696–700

    Article  PubMed  CAS  Google Scholar 

  42. Dahl OE, Andreassen G, Müller C, et al. The effect of prolonged thromboprophy Iaxis with dalteparin on the frequency of deep vein thrombosis (DVT) and pulmonary embolism (PE) 35 days after hip replacement surgery (HRS). Thromb Haemost 1995; 73: 1094

    Google Scholar 

  43. Lassen MR, Borris LC, On behalf of the Danish Prolonged Prophylaxis Study Group. Prolonged thromboprophylaxis with low molecular weight heparin (Fragmin) after elective total hip arthroplasty — a placebo-controlled study. Thromb Haemost 1995; 73: 1104

    Google Scholar 

  44. Planes A, Vochelle N, Darmon J-V, et al. Efficacy and safety of post-discharge administration of enoxaparin in the prevention of deep venous thrombosis after total hip replacement: a prospective randomised double-blind placebo-controlled trial. Drugs 1996; 52 Suppl. 7: 47–54

    Article  PubMed  Google Scholar 

  45. Nylander G. Phlebographic diagnosis of acute deep leg thrombosis. Acta Chir Scand 1967; 30 Suppl. 387: 30–4

    Google Scholar 

  46. Zagrodnik J, Kaufner HK. Ambulante Thromboembo-lieprophylaxe in der Tramatologie durch Selbstinjektion von Heparin. Unfallchirurg 1990; 92: 331–3

    Google Scholar 

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

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Vascular Surgery, University Hospital, Uppsala University, S-751 85, Uppsala, Sweden

    David Bergqvist

Authors
  1. David Bergqvist
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bergqvist, D. The Postdischarge Risk of Venous Thromboembolism after Hip Replacement. Drugs 52 (Suppl 7), 55–59 (1996). https://doi.org/10.2165/00003495-199600527-00010

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-199600527-00010

Keywords

Search

Navigation