Bruce L. Davidson, MD, MPH; Anthonie W.A. Lensing, MD, PhD
Davidson B., Lensing A.; Prolonged Prophylaxis after Joint Replacement: Another Step Sideways?. Ann Intern Med. 2000;132:914-915. doi: 10.7326/0003-4819-132-11-200006060-00011
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Published: Ann Intern Med. 2000;132(11):914-915.
It is generally accepted that perioperative prophylaxis against venous thromboembolism is important for patients undergoing hip and knee replacement. Even before shortened hospitalizations, there was a tendency to extend prophylaxis into the outpatient setting. If prolonged prophylaxis after joint replacement were proven safe and effective for preventing not only clots but their clinical sequelae and were also convenient and inexpensive, it would not be controversial. Unfortunately, this is not the case.
Strong clinical evidence supports the safety and effectiveness of low-molecular-weight heparin in preventing venographically demonstrable thrombosis in patients undergoing hip replacement; incidence is reduced by approximately 50% (1-6). Any clinician caring for diabetic patients, most of whom self-inject twice daily for life, cannot seriously argue that 20 to 30 days of once-daily subcutaneous self-injection at home during rehabilitation from joint replacement surgery is truly inconvenient. Therefore, the validity of prolonged prophylaxis against venous thromboembolism and the controversy surrounding it center on whether the practice prevents clinical sequelae and is worth the cost.
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Hospital Medicine, Venous Thromboembolism, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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