Preoperative Identification of Patients at High Risk of Deep Venous Thrombosis Despite Prophylaxis in Total Hip Replacement

E Rocha; M J Alfaro; J A Páramo; J M Cañadell

doi:10.1055/s-0038-1646772

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 1988; 59(01): 093-095
DOI: 10.1055/s-0038-1646772

Review Article

Schattauer GmbH Stuttgart

Preoperative Identification of Patients at High Risk of Deep Venous Thrombosis Despite Prophylaxis in Total Hip Replacement

Authors

E Rocha

^*The Hematology Service and Orthopedic Surgery Department, University Clinic, University of Navarra, Pamplona, Spain
M J Alfaro

^*The Hematology Service and Orthopedic Surgery Department, University Clinic, University of Navarra, Pamplona, Spain
J A Páramo

^*The Hematology Service and Orthopedic Surgery Department, University Clinic, University of Navarra, Pamplona, Spain
J M Cañadell

^*The Hematology Service and Orthopedic Surgery Department, University Clinic, University of Navarra, Pamplona, Spain

Abstract

PDF Download

Summary

Clinical and laboratory variables were measured on the day before operation in 111 patients who underwent total hip replacement prophylactically treated with acetylsalicilic acid or heparin-dihydroergotamine. Postoperative deep vein thrombosis (DVT) was deteced in 16 patients by ascending venography. Stepwise logistic discriminant analysis was used to identify DVT predicting factors. Three such factors, fibrinogen degradation products (FDP), plasminogen activator inhibitor (PA-inhibitor) and tissue type plasminogen activator (t-PA), were found to be significantly associated with DVT and were used to construct a predictive index. The predictive index, I = —2.09 + 0.46 (FDP) +1.39 (PA-inhibitor)-0.24 (t-PA), was 100% sensitive and 95% specific in the prediction of DVT. This index would allow for identification of those patients in whom routine prophylaxis would be sufficient and for selecting those in whom more effective prophylactic regimens would be necessary.

Key words

Predictive index - Deep vein thrombosis - Total hip replacement - Surgery

PDF (285 kb)

References

References
1 Nillius AS, Nylander G. Deep vein thrombosis after total hip replacement: A clinical and phlebographic study. Br J Surg 1979; 66: 324-326
2 Sikorski JM, Hampson WG, Staddon GE. The natural history and etiology of deep vein thrombosis after total hip replacement. J Bone Joint Surg 1981; 63B: 171-177
3 Clayton JK, Anderson JA, McNicol GP. Preoperative prediction of postoperative deep vein thrombosis. Br Med J 1976; 2: 910-911
4 Lowe GD O, Osborne DH, McArdle BM. et al. Prediction and selective prophylaxis of venous thrombosis in elective gastrointestinal surgery. Lancet 1982; 1: 409-412
5 Sue-Ling HM, Johnston D, McMahon MJ, Philips PR, Davies JA. Pre-operative identification of patients at high risk of deep venous thrombosis after elective major abdominal surgery. Lancet 1986; 1: 1173-1176
6 Alfaro MJ, Páramo JA, Rocha E. Prophylaxis of thromboembolic disease and platelet related changes following total hip replacement: A comparative study of aspirin and heparin-dihydroergotamine. Thromb Haemostas 1986; 56: 53-56
7 Páramo JA, Rocha E. Changes in coagulation and fibrinolysis after total hip replacement and their relations with deep vein thrombosis. Haemostasis 1985; 15: 345-352
8 Páramo JA, Rocha E. Deep vein thrombosis and related platelet changes after total hip replacement. Haemostasis 1985; 15: 389-394
9 Páramo JA, Alfaro MJ, Rocha E. Postoperative changes in the plasmatic levels of tissue-type plasminogen activator and its fast-acting inhibitor. Relationship to deep vein thrombosis and influence of prophylaxis. Thromb Haemostas 1985; 54: 713-716
10 BMDP statistical software, University of California Press. Berkeley 1981
11 Kjaergaard J, Esbensen K, Wille-jørgensen P. et al. A multivariate pattern recognition study of risk-factors indicating postoperative thromboembolism despite low-dose heparin in major abdominal surgery. Thromb Haemostas 1985; 54: 409-412
12 Veth G, Meuwissen Th JO A, Van Houwelingen HC, Sixma JJ. Prevention of postoperative deep vein thrombosis by a combination of subcutaneous heparin with subcutaneous dihydroergotamine or oral sulphinpyrazone. Thromb Haemostas 1985; 54: 570-573
13 Sautter RD, Myers WO, Ray III JF, Wenzel FJ. Relationship of the fibrinolytic system to postoperative thrombotic phenomena. Arch Surg 1973; 107: 292-296
14 Knight MT N, Dawson R, Melrose DG. Fibrinolytic response to surgery. Labile and stable patterns and their relevance to postoperative deep vein thrombosis. Lancet 1977; 1: 370-373
15 Turpie A, Levine MN, Hirsh J. et al. A randomized controlled trial of low-molecular-w-eight heparin (enoxaparin) to prevent deep-vein thrombosis in patients undergoing elective hip surgery. N Eng J Med 1986; 315: 925-929