OTHER DVT PREVENTION METHODS

ASPIRIN​ 


Thromboembolism Prophylaxis in Hip Arthroplasty: Routine and High Risk Patients.
Nam D1, Nunley RM1, Johnson SR1, Keeney JA1, Clohisy JC1, Barrack RL1.

Abstract
This study's purpose was to present the use of a risk stratification protocol in which "routine" risk patients receive a mobile compression device with aspirin and "high" risk patients receive warfarin for thromboprophylaxis after hip arthroplasty. 1859 hip arthroplasty patients were prospectively enrolled (1402 routine risk--75.4%, 457 high risk--24.6%). The cumulative rate of venous thromboembolism events was 0.5% in the routine versus 0.5% in the high-risk cohort within 6weeks postoperatively (P=1.00). Patients in the routine risk cohort had a lower rate of major bleeding (0.5% versus 2.0%, P=0.006) and wound complications (0.2% versus 1.2%, P=0.01). Use of our risk stratification protocol allowed the avoidance of more aggressive anticoagulation in 75% of patients while achieving a low overall incidence of symptomatic VTE.





325 mg of Aspirin twice daily

The Effectiveness of a Risk Stratification Protocol for Thromboembolism Prophylaxis After Hip and Knee Arthroplasty.
Nam D1, Nunley RM1, Johnson SR1, Keeney JA2, Clohisy JC1, Barrack RL1.

Abstract
BACKGROUND: 
This study's purpose was to present our institution's experience with the use of a risk stratification protocol for venous thromboembolism (VTE) prophylaxis in joint arthroplasty in which "routine" risk patients receive a mobile compression device in conjunction with aspirin and "high"-risk patients receive warfarin for thromboprophylaxis.
METHODS: 
This was a prospective study of patients undergoing primary or revision knee or hip arthroplasty. Exclusion criteria were patients with a current deep vein thrombosis, history of pulmonary embolism, chronic warfarin therapy, planned multiple surgeries, and prolonged postoperative immobilization. Patients were stratified as either routine or high risk. Routine risk patients received mobile compression devices for 10 days and aspirin twice daily for 6 weeks, whereas high-risk patients received warfarin for 4 weeks and compression stockings for 6 weeks.
RESULTS: 
A total of 3143 total joint arthroplasties were enrolled (2222, 70.7% "routine"; 921, 29.3% "high risk"). The rate of symptomatic VTE within 6 weeks postoperatively was 0.7% (95% CI 0.3%-1.0%) in the standard vs 0.5% (95% CI 0.01%-1.0%) in the high-risk cohort (P = .67), and within 6 months postoperatively was 0.6% (95% CI 0.3%-1.0%) in the standard vs 1.1% (95% CI 0.4%-1.8%) in the high-risk cohort (P = .23). The rate of major bleeding events was significantly lower in the routine (0.4%; 95% CI 0.1%-0.6%) vs high-risk (2.0%; 95% CI 1.0%-3.0%; P < .001) cohort.
CONCLUSIONS: 
This study demonstrates that use of a risk stratification protocol allowed the avoidance of more aggressive anticoagulation in 70% of patients while achieving a low overall incidence of symptomatic VTE.

Both the ACCP and the AAOS recognize aspirin as a safe and effective form of VTE prophylaxis.  
Many Orthopedic surgeons prefer Mobile SCDs & Aspirin for the majority of their patients that fall into the routine risk category for DVT to reduce the risk of bleeding complications associated with blood thinners. 

BLOOD THINNERS

      

Wall Street Journal
"Almost half of clots strike patients when they are in the hospital or soon after discharge, ranking them among the most common causes of preventable deaths. Guidelines for preventing clots are in place, yet studies show that 40% to 60% of patients who would benefit don't receive appropriate treatments. They aren’t given anticlotting drugs because hospitals don’t reliably administer them and patients sometimes refuse them."


   
Full Article

COMPRESSION STOCKINGS

Compression stockings (also known as TED stockings) are commonly regarded as a safe and noninvasive method for preventing VTE. However, evidence in support of their efficacy is lacking. A recent consensus statement from the American College of Physicians recommended “against the use of mechanical prophylaxis with graduated compression stockings for prevention of venous thromboembolism  in medical and stroke patients. In support of their recommendation, the authors of this consensus statement cite a lack of evidence of benefit and significant evidence of patient harm related to skin breakdown from compression stockings. 

AMBULATION 

"Ambulation is certainly good care... but there isn't really any strong data that ambulation alone prevents blood clots. That's actually one of the myths we've been trying to fight." - Dr Elliott Haut, John's Hopkins Associate Professor of Surgery and Anesthesiology. Quote taken from video above regarding Blood Thinners.