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• W2000324293 abstract "The risks of deep venous thrombosis (DVT) and pulmonary embolism (PE) after total hip replacement (THR) surgery can be reduced by effective antithrombotic prophylaxis. Traditionally, prophylaxis is discontinued when the patient is discharged from hospital, a practice based largely on convenience. Due to recent trends to reduce the length of postoperative hospital stay, patients may be discharged while still at risk for postoperative venous thromboembolism. A number of reports have expressed concern over delayed thromboembolism after hospital discharge, 1 Johnson R Green JR Charnley J Pulmonary embolism and its prophylaxis following the Charnley total hip replacement. Clin Orthop. 1977; 127: 123-132 PubMed Google Scholar , 2 Sikorski JM Hampson WG Staddon GE The natural history and aetiology of deep vein thrombosis after total hip replacement. J Bone Joint Surg [Br]. 1981; 63-B: 171-177 PubMed Google Scholar , 3 Kakkar W Fok PJ Murray WJG et al. Heparin and dihydroergotamine prophylaxis against thrombo-embolism after hip arthroplasty. J Bone Joint Surg [Br]. 1985; 67: 538-542 PubMed Google Scholar , 4 Swierstra BA Stibbe J Schouten HJA Prevention of thrombosis after hip arthroplasty: a prospective study of preoperative oral anticoagulants. Acta Orthop Scand. 1988; 59: 139-143 PubMed Google Scholar , 5 Scurr JH Coleridge-Smith PD Hasty JH Deep venous thrombosis: a continuing problem. BMJ. 1988; 297: 28 Crossref PubMed Scopus (121) Google Scholar , 6 Huber O Bounameaux H Borst F et al. Postoperative pulmonary embolism after hospital discharge: an underestimated risk. Arch Surg. 1992; 127: 310-313 Crossref PubMed Scopus (306) Google Scholar even when patients have normal venogram findings at discharge. 7 Mätzsch T Bergqvist D Fredin H et al. Low molecular weight heparin compared with dextran as prophylaxis against thrombosis after total hip replacement. Acta Chir Scand. 1990; 156: 445-450 PubMed Google Scholar , 8 Mätzsch T Bergqvist D Fredin H et al. Comparison of the thromboprophylactic effect of a low molecular weight heparin versus dextran in total hip replacement. Thromb Haemorrh Disord. 1991; 3: 25-29 Google Scholar , 9 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: 543-548 Crossref PubMed Scopus (223) Google Scholar , 10 Bailey JP Kruger MP Solano FX et al. Prospective randomized trial of sequential compression devices vs low-dose warfarin for deep venous thrombosis prophylaxis in total hip arthroplasty. J Arthroplasty. 1991; 6: 29-35 Abstract Full Text PDF PubMed Scopus (59) Google Scholar , 11 The Danish Enoxaparin Study GroupLow-molecular weight heparin (enoxaparin) vs dextran 70: the prevention of postoperative deep vein thrombosis after total hip replacement. Arch Intern Med. 1991; 151: 1621-1624 Crossref PubMed Scopus (96) Google Scholar , 12 Hoek JA Nurmohamed MT Hamelynck KJ et al. Prevention of deep vein thrombosis following total hip replacement by low molecular weight heparinoid. Thromb Haemost. 1992; 67: 28-32 PubMed Google Scholar , 13 Hull R Raskob G Pineo G et al. A comparison of subcutaneous low-molecular-weight heparin with warfarin sodium for prophylaxis against deep-vein thrombosis after hip or knee implantation. N Engl J Med. 1993; 329: 1370-1376 Crossref PubMed Scopus (444) Google Scholar , 14 Arcelus JI Caprini JA Traverso CI Venous thromboembolism after hospital discharge. Semin Thromb Hemost. 1993; 19: 142-146 PubMed Google Scholar , 15 Colwell CW Spiro TE Trowbridge AA et al. Use of enoxaparin, a low-molecular-weight heparin, and unfractionated heparin for the prevention of deep venous thrombosis after elective hip replacement: a clinical trial comparing efficacy and safety. J Bone Joint Surg Am. 1994; 76: 3-14 Crossref PubMed Scopus (220) Google Scholar , 16 Spiro TE Johnson GJ Christie MJ et al. Efficacy and safety of enoxaparin to prevent deep venous thrombosis after hip replacement surgery. Ann Intern Med. 1994; 121: 81-89 Crossref PubMed Scopus (115) Google Scholar Seagroatt et al 17 Seagroatt V Tan HS Goldacre M et al. Elective total hip replacement: incidence, emergency readmission rate, and postoperative mortality. BMJ. 1991; 303: 1431-1435 Crossref PubMed Scopus (209) Google Scholar reported that DVT was the most common cause of readmission to hospital after THR. In contrast, a low incidence of symptomatic venous thromboembolism among orthopedic patients with normal venogram results at hospital discharge has also been reported. 13 Hull R Raskob G Pineo G et al. A comparison of subcutaneous low-molecular-weight heparin with warfarin sodium for prophylaxis against deep-vein thrombosis after hip or knee implantation. N Engl J Med. 1993; 329: 1370-1376 Crossref PubMed Scopus (444) Google Scholar , 14 Arcelus JI Caprini JA Traverso CI Venous thromboembolism after hospital discharge. Semin Thromb Hemost. 1993; 19: 142-146 PubMed Google Scholar , 15 Colwell CW Spiro TE Trowbridge AA et al. Use of enoxaparin, a low-molecular-weight heparin, and unfractionated heparin for the prevention of deep venous thrombosis after elective hip replacement: a clinical trial comparing efficacy and safety. J Bone Joint Surg Am. 1994; 76: 3-14 Crossref PubMed Scopus (220) Google Scholar , 16 Spiro TE Johnson GJ Christie MJ et al. Efficacy and safety of enoxaparin to prevent deep venous thrombosis after hip replacement surgery. Ann Intern Med. 1994; 121: 81-89 Crossref PubMed Scopus (115) Google Scholar , 17 Seagroatt V Tan HS Goldacre M et al. Elective total hip replacement: incidence, emergency readmission rate, and postoperative mortality. BMJ. 1991; 303: 1431-1435 Crossref PubMed Scopus (209) Google Scholar , 18 Sharrock NE Brien WW Salvati EA et al. The effect of intravenous fixed-dose heparin during total hip arthroplasty on the incidence of deep-vein thrombosis: a randomized, double-blind trial in patients operated on with epidural anesthesia and controlled hypotension. J Bone Joint Surg [Am]. 1990; 72: 1456-1461 Crossref PubMed Scopus (57) Google Scholar , 19 Woolson ST McCrory DW Walter JF et al. B-mode ultrasound scanning in the detection of proximal venous thrombosis after total hip replacement. J Bone Joint Surg [Am]. 1990; 72: 983-987 Crossref PubMed Scopus (76) Google Scholar , 20 Agnelli G Ranucci V Veschi F et al. Clinical outcome of orthopaedic patients with negative lower limb venography at discharge. Thromb Haemost. 1995; 74: 1042-1044 PubMed Google Scholar Some investigators conclude that orthopedic patients can be discharged without continuing prophylaxis, an approach that is followed by many orthopedic surgeons; 21 Paiement GD Wessinger SJ Harris WH Survey of prophylaxis against venous thromboembolism in adults undergoing hip surgery. Clin Orthop. 1987; 223: 188-193 PubMed Google Scholar , 22 Laverick MD Croal SA Mollan RA Orthopaedic surgeons and thromboprophylaxis. BMJ. 1991; 303: 549-550 Crossref PubMed Scopus (68) Google Scholar others recommend that prophylactic treatment be continued after discharge. 23 Amstutz HC Friscia DA Dorey F et al. Warfarin prophylaxis to prevent mortality from pulmonary embolism after total hip replacement. J Bone Joint Surg [Am]. 1989; 71: 321-326 Crossref PubMed Scopus (97) Google Scholar , 24 Tremaine MD Choroszy CJ Menking SA Deep vein thrombosis in the total hip arthroplasty patient after hospital discharge. J Vasc Technol. 1991; 15: 205-206 Google Scholar , 25 Paiement GD Wessinger SJ Hughes R et al. Routine use of adjusted low-dose warfarin to prevent venous thromboembolism after total hip replacement. J Bone Joint Surg Am. 1993; 75: 893-898 Crossref PubMed Scopus (71) Google Scholar , 26 Lotke PA Steinberg ME Ecker ML Significance of deep venous thrombosis in the lower extremity after total joint arthroplasty. Clin Orthop. 1994; 299: 25-30 PubMed Google Scholar , 27 Trowbridge A Boese CK Woodruff B et al. Incidence of posthospitalization proximal deep venous thrombosis after total hip arthroplasty: a pilot study. Clin Orthop. 1994; 299: 203-208 PubMed Google Scholar In 1992, the European Consensus Statement identified the issue of postdischarge prophylaxis as a key question to be answered by appropriately designed prospective trials. 28 Nicolaides AN Arcelus J Belcaro G Prevention of venous thromboembolism: European Consensus Statement, 1–5 November 1991. Int Angiol. 1992; 11: 151-159 PubMed Google Scholar" @default.
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