Prevention of venous thromboembolism in major lower limb orthopaedic surgery using aspirin: A retrospective cohort study
Journal Title: Medpulse International Journal of Orthopedics - Year 2018, Vol 5, Issue 1
Abstract
We did a retrospective cohort study using prospectively collected data of consecutive 993 patients undergoing major orthopaedic lower limb surgery including all hip and knee primary and revision arthroplasties, acetabulum and pelvic fracture fixations, hip fracture surgeries including neck femur and intertrochanteric fractures, interlocking nailing femur and tibia and external fixations femur and tibia from April 2008 to March 2016 at our institution. All cases excluding cancer and previous VTE or patients already on any kind of antithrombotic prophylaxis were started on aspirin 75 mg (low dose) on 3rd postoperative day. An early ambulation, ≤ 3 postoperative day protocol was followed. We preoperatively assessed the risks of pulmonary embolism and bleeding complications in all patients using medical history and laboratory results. Then all patients were stratified into 2 groups, based on the thorough preoperative risks assessments: 1) standard risks for both PE and bleeding, 2) increased risk for PE and standard risk for bleeding. Risk assessment criteria were based on the 1st AAOS guideline and National Institute for Health and Clinical Excellence (NICE) guideline issued in 2007. Also a preoperative Well’s score was calculated for all the enrolled patients and a measurement of calf circumference was taken ten centimetres from the tibial tuberosity of both the limbs on admission and at every two days postoperative till the patient was discharge from hospital. Duration of treatment with aspirin (75mg) was three months with continued active physiotherapy. All patients with morbid obesity were treated with LMW heparin and were excluded from the study. Outcome evaluation: All patients were evaluated until 3 months after surgery, concerning the efficacy of the treatment i.e. overall incidence of symptomatic DVT or PE. All patients were routinely required to visit outpatient clinic at 2 weeks, 6 weeks and 3 months after surgery, and educated to visit emergency unit if any suspicious symptoms of PE developed. If a patient has symptoms which can make suspicion of DVT or PE, or a difference in calf circumference > 3 cm from opposite limb in case of unilateral surgery and from preoperative calf circumference from same limb in case of bilateral limb surgeries, a venous Doppler ultrsonographic examination and Ddimer levels were checked. Suspicious symptoms or signs of DVT are pain, edema, warmth or erythema of the leg or thigh and Homan’s sign, and those of PE are chest pain or discomfort and dyspnea.
Authors and Affiliations
Nitin Bansal, Rajinder Kumar, Amrinder Singh, Swapnil Sharma, Gaurav Jain
Keywords
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