Warfarin prophylaxis and venous thromboembolism in the first 5 days following hip and knee arthroplasty

Daniel J. Brotman; Amir K. Jaffer; Jason G. Hurbanek; Nariman Morra

doi:10.1160/TH04-04-0204

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2004; 92(05): 1012-1017
DOI: 10.1160/TH04-04-0204

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Warfarin prophylaxis and venous thromboembolism in the first 5 days following hip and knee arthroplasty

Daniel J. Brotman

¹Department of General Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA

,

Amir K. Jaffer

¹Department of General Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA

,

Jason G. Hurbanek

²Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA

,

Nariman Morra

¹Department of General Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA

› Author Affiliations

Abstract

Summary

Many orthopaedic surgeons use warfarin to prevent venous thromboembolism (VTE) following hip or knee arthroplasty. Since warfarin’s antithrombotic effects are delayed, we hypothesized that early VTE (occurring within 5 days post-operatively) would be more common in arthroplasty patients receiving warfarin monotherapy compared to those receiving enoxaparin. We performed a secondary analysis of a case-control study examining risk factors for post-operative thrombosis in postmenopausal women. We defined cases as patients who were diagnosed with thrombosis within 5 days of surgery. Controls without thrombosis were matched with cases by age, surgeon, year of surgery and surgical joint. 84 women with early post-operative thrombosis (cases) were matched with 206 controls. 18 cases (21.4%) had been prescribed warfarin monotherapy, compared with 7 controls (3.4%). 58 (69.1%) cases and 195 (94.7%) controls had been prescribed subcutaneous enoxaparin 30 mg twice daily, starting 12-24 hours after surgery. The odds ratio for any early thrombosis in patients receiving warfarin as opposed to enoxaparin 30 mg twice daily was 8.6 (p<0.0001). For proximal thrombosis, the odds ratio was 11.3 (p<0.0001). Multivariate analysis did not alter these findings. Warfarin’s delayed antithrombotic effects may not provide adequateVTE prophylaxis in the immediate post-operative setting. We suggest caution in employing warfarin monotherapy following joint arthroplasty.

Keywords

Warfarin - enoxaparin - arthroplasty - venous thromboembolism - post-operative

Full Text

References

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