Bleeding complications after systematic switch of routine thromboprophylaxis for major orthopaedic surgery

Summary

The rate of bleeding complications after major orthopedic surgery approximates 2%. It is unclear whether a systematic switch of routine thromboprophylaxis has an impact on the rate of postoperative bleeding complications. We analyzed prospectively recorded postoperative bleeding complications and symptomatic venous thromboembolic events in 8,176 consecutive orthopedic patients at the Schulthess Clinic Zurich during a systematic switch of thromboprophylaxis from nadroparin to enoxaparin in the year 2004. Overall, 3,893 patients received nadroparin in the first nine-month observation period before the switch and 4,283 patients received enoxaparin in the second nine-month observation period after the switch. Overall, 96 (2.5%) patients in the first period and 70 (1.6%) patients in the second period suffered a postoperative bleeding complication requiring surgical revision, puncture, or transfusion (p<0.01). Five objectively confirmed symptomatic venous thromboembolic events during hospitalization in the first period and three events in the second period were recorded. In conclusion, the switch of thromboprophylaxis in a large orthopedic clinic did not cause an increase of postoperative bleeding complications and therefore was accompanied by high patient safety.

Keywords

Thromboprophylaxis - bleeding complications - venous thromboembolism - orthopedic surgery

• References

• 1 The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126: 163S-696S.
• 2 Geerts WH, Heit JA, Clagett GP. et al. Prevention of venous thromboembolism. Chest 2001; 119: 132S-175S.
• 3 Anderson FA, Wheeler HB, Goldberg RJ. et al. A population- based perspective of the hospital incidence and case fatality rates of deep vein thrombosis and pulmonary embolism: the Worcester DVT Study. Arch Intern Med 1991; 151: 933-938.
• 4 Douketis JD, Eikelboom JW, Quinlan DJ. et al. Short duration prophylaxis against venous thromboembolism after total hip or knee replacement: a metaanalysis of prospective studies investigating symptomatic outcomes. Arch Intern Med 2002; 162: 1465-1471.
• 5 White RH, Romano PS, Zhou H. et al. Incidence and time course of thromboembolic outcomes following total hip or knee arthroplasty. Arch Intern Med 1998; 158: 1525-1531.
• 6 Dahl OE, Caprini JA, Colwell CW. et al. Fatal vascular outcomes following major orthopedic surgery. Thromb Haemost 2005; 93: 860-866.
• 7 Freedman KB, Brookenthal KR, Fitzgerald RH. et al. A meta-analysis of thromboembolic prophylaxis following elective total hip arthroplasty. J Bone Joint Surg Am 2000; 82: 929-938.
• 8 Westrich GH, Haas SB, Mosca P. et al. Meta-analysis of thromboembolic prophylaxis after total knee arthroplasty. J Bone Joint Surg Br 2000; 82: 795-800.
• 9 Prandoni P. Heparins and venous thromboembolism: Current practice and future directions. Thromb Haemost 2001; 86: 488-498.
• 10 Planes A, Vochelle N, Mazas F. et al. A randomized trial comparing unfractioned heparin with low molecular weight heparin in patients undergoing total hip replacement. Thromb Haemost 1998; 60: 407-410.
• 11 Keppel G. Design and analysis: A researchers' handbook. 3rd ed.. Englewood Cliffs, NJ: Prentice-Hall; 1991
• 12 Raskob GE, Hirsch J. Controversies in timing of the first dose of anticoagulant prophylaxis against venous thromboembolism after major orthopedic surgery. Chest 2003; 124: 379S-385S.
• 13 Schellong S, Hesseschwerdt HJ, Paar WD. et al. Rates of proximal deep vein thrombosis as assessed by compression ultrasonography in patients receiving prolonged thromboprophylaxis with low molecular weight heparin after major orthopedic surgery. Thromb Haemost 2005; 94: 532-536.