Background: Total hip (THA) and knee arthroplasty (TKA) are considered high risk procedures for venous thromboembolic events (VTE) such as deep venous thrombosis (DVT) and pulmonary embolism (PE). Consequently, guidelines recommend chemical thromboprophylaxis for 10-35 days after surgery [1] However, reports of 90-days VTE rates of about 0.4% in fast-track THA and TKA with only in-hospital prophylaxis [2] have led to suggestions of only in-hospital prophylaxis in selected fast-track procedures [3], despite a current lack of follow-up studies. 

Goal of Study: To investigate 90-days symptomatic VTE and arterial thromboembolic events (ATE) with only in-hospital prophylaxis in fast-track THA and TKA. 

Methods: Prospective cohort study from 2012-2015 in elective unilateral THA and TKA with only in-hospital thromboprophylaxis when length of hospital stay (LOS) ≤5 days. Prospective information on comorbidity and 90-days follow-up on readmissions/mortality from the Danish National patient registry. Evaluation of discharge and medical records in case of VTE or ATE. Patients with preoperative use of anticoagulants were excluded (≈5%).

Results: Of 18241 procedures, 17474 (96%) had LOS ≤5 days (median 2 days (IQR 2-3)), with 6.8% readmission and 0.2% mortality rates. Median age was 68 yrs, 59% were women and 52% had THA. VTE and ATE rates were 0.3% and 0.4%, respectively.

Figure2

The 716 patients with LOS >5 days (median 8 days (IQR 7-10)), had 15% readmission and 1,7% mortality rate.  VTE and ATE rates were 2.4% and 3.8%, respectively.Figure1

Conclusion: We found similar results as in our previous study [2], confirming the safety of only in-hospital prophylaxis in fast-track THA and TKA with a LOS of ≤5 days.

References:
[1] Falck-Ytter et al. Chest. 2012;141:e278S-e325S
[2] Jørgensen et al. BMJ Open. 2013;3:e003965
[3] Venclauskas et al. Eur J Anaesthesiol. 2017;35:134-138.


05 / Frequency of symptomatic thromboembolic events with thromboprophylaxis only during hospitalisation in fast-track total hip and knee arthroplasty, a prospective follow-up study.