Ultrasound screening for distal vein thrombosis is not beneficial after major orthopedic surgery.

Benjamin Schmidt; Ronny Michler; Martin Klein; Grit Faulmann; Christian Weber; Sebastian Schellong

doi:10.1160/TH03-03-0154

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2003; 90(05): 949-954
DOI: 10.1160/TH03-03-0154

New Technologies and Diagnostic Tools

Schattauer GmbH

Ultrasound screening for distal vein thrombosis is not beneficial after major orthopedic surgery.

A randomized controlled trial

Benjamin Schmidt

¹Division of Angiology, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany

,

Ronny Michler

¹Division of Angiology, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany

,

Martin Klein

²Asklepios Orthopedic Hospital Hohwald, Hohwald/Sachsen, Germany

,

Grit Faulmann

¹Division of Angiology, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany

,

Christian Weber

²Asklepios Orthopedic Hospital Hohwald, Hohwald/Sachsen, Germany

,

Sebastian Schellong

¹Division of Angiology, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany

› Author Affiliations

Abstract

Summary

Ultrasound screening for deep vein thrombosis (DVT) after orthopedic surgery revealed thrombosis in up to 30% of patients, but the clinical impact of screening for distal thrombosis has not been established.

Three hundred and forty six patients after hip or knee replacement and postoperative standard prophylaxis of 10 days low molecular weight heparin (LMWH) were randomized to receive either prolonged prophylaxis with LMWH or postoperative ultrasound screening for proximal and distal thrombosis. All thrombosis found in screening was treated. Patients with a negative screening test did not receive any heparin after day 10. The cumulative rate of proximal thrombosis and symptomatic pulmonary embolism until day 35 postoperatively was determined.

In 174 screening patients, ultrasound found 55 cases of distal (31.6%) and 9 cases of proximal (5.1%) in-hospital thrombosis. In 108 screening patients without thrombosis at discharge 7 new distal (6.5%) and 6 new proximal (5.6%) thrombotic events occurred by day 35. In 163 patients with prolonged prophylaxis, 33 cases of distal (20.2%) and 7 cases of proximal (4,3%) thrombotic events occurred by day 35. The cumulative rate of proximal events was 8,7% in the screening group and 4.3% in the prophylaxis group (p=0.12).

In conclusion, ultrasound screening for thrombosis does not reduce the rate of proximal thrombosis and symptomatic pulmonary embolism 35 days after hip or knee replacement surgery.

Keywords

Ultrasound screening - venous thromboembolism - orthopedic surgery - prophylaxis

Full Text

References

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