The Value of Ultrasound Screening for Proximal Vein Thrombosis after Total Hip Arthroplasty

Fabio Verlato; Olinto Bruchi; Paolo Prandoni; Giuseppe Camporese; Gianni Maso; Flavio Busonera; Antonio Girolami; Giuseppe Maria Andreozzi; for the W. O. D. O. S. Investigators Group

doi:10.1055/s-0037-1616082

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2001; 86(02): 534-537
DOI: 10.1055/s-0037-1616082

Review Article

Schattauer GmbH

The Value of Ultrasound Screening for Proximal Vein Thrombosis after Total Hip Arthroplasty

A Prospective Cohort Study

Fabio Verlato

¹Unit Care of Angiology

,

Olinto Bruchi

²S. Anthony Unit Care of Anesthesiology

,

Paolo Prandoni

³Second Department of Internal Medicine, University Hospital of Padua, Italy

,

Giuseppe Camporese

¹Unit Care of Angiology

,

Gianni Maso

²S. Anthony Unit Care of Anesthesiology

,

Flavio Busonera

¹Unit Care of Angiology

,

Antonio Girolami

³Second Department of Internal Medicine, University Hospital of Padua, Italy

,

Giuseppe Maria Andreozzi^*

¹Unit Care of Angiology

,

for the W. O. D. O. S. Investigators Group

› Author Affiliations

Abstract

Summary

The role of ultrasound screening for proximal deep-vein thrombosis (DVT) following major hip surgery is controversial. 202 consecutive patients, who had received warfarin prophylaxis after total hip arthroplasty underwent a bilateral ultrasound assessment of the proximal vein system (using the criterion of vein compressibility) before hospital discharge. In the 9 patients (4.5%; 95% CI, 2.1-8.3%) with positive test anticoagulant treatment was successfully continued for three months. In all the remaining 193 patients the warfarin treatment was withdrawn. A second ultrasound test was performed 15 days later, and showed a new (asymptomatic) abnormality compatible with proximal DVT in 2 patients (1.0%; 95% CI, 0.1-3.7%). All other 191 patients remained asymptomatic until the completion of a 3-month follow-up period (rate of symptomatic thromboembolism, 0/191, 0%; 95% CI, 0-1.9%).

Because of the relatively high incidence of proximal DVT in patients undergoing major orthopaedic surgery under warfarin prophylaxis, screening for proximal DVT at hospital discharge in these patients is indicated. The negativity of this test has the potential of safely preventing the extension of anticoagulation beyond hospital stay. A larger controlled study in which the value of this strategy is tested against the prolongation of oral anticoagulation in patients with a negative ultrasound screening at discharge is indicated.

Keywords

Ultrasound - deep vein thrombosis - hip arthroplasty - oral anticoagulants

Full Text

References

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