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Ultrasonographic Screening before Hospital Discharge for Deep Venous Thrombosis after Arthroplasty: The Post-Arthroplasty Screening Study: A Randomized, Controlled Trial

K. Sue Robinson, MD; David R. Anderson, MD; Michael Gross, MD; David Petrie, MD; Ross Leighton, MD; William Stanish, MD; David Alexander, MD; Michael Mitchell, MD; Bruce Flemming, MD; and Michael Gent, DSc
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From Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada; and the Hamilton Civic Hospitals Research Centre and McMaster University, Hamilton, Ontario, Canada. Acknowledgments: The authors thank the nurses on the orthopedic units and the technologists in the ultrasound department of the Victoria General Hospital for their support. They also thank Marlene Fairhurst-Vaughan, RN, Elizabeth Boyle, RN, Kim Parkhill, RN, Cheryl Forbes, RN, Erica Burton, BSc, and Richard Karis for their assistance and Linda Woodbury for secretarial assistance. Grant Support: In part by a grant from the Medical Research Council of Canada. Dr. Anderson is a Research Scholar of the Canadian Heart and Stroke Foundation. Requests for Reprints: David R. Anderson, MD, Room 132, West Wing Mackenzie Building, Queen Elizabeth II Health Sciences Centre, 1278 Tower Road, Halifax, Nova Scotia B3H 2Y9, Canada. Current Author Addresses: Drs. Robinson, Anderson, Gross, Petrie, Leighton, Stanish, Alexander, Mitchell, and Flemming: Queen Elizabeth II Health Sciences Centre, 1278 Tower Road, Halifax, Nova Scotia B3H 2Y9, Canada.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;127(6):439-445. doi:10.7326/0003-4819-127-6-199709150-00004
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Background: The clinical significance of asymptomatic deep venous thrombosis that develops after joint arthroplasty and the value of screening tests to detect thrombi are uncertain.

Objectives: To determine 1) the rate of symptomatic deep venous thrombosis or pulmonary embolism occurring after hospitalization for joint arthroplasty and 2) the value of screening compression ultrasonography.

Design: Double-blind, randomized, controlled trial.

Setting: Tertiary care hospital.

Patients: 1024 patients undergoing elective total hip or knee arthroplasty who received warfarin prophylaxis.

Intervention: Patients were randomly assigned to undergo either bilateral compression ultrasonography or a sham procedure before hospital discharge. Patients with a diagnosis of asymptomatic deep venous thrombosis were treated after discharge with standard anticoagulant therapy; other patients had warfarin therapy discontinued at discharge. All patients were followed for 90 days.

Results: In the screening group, asymptomatic proximal deep venous thrombosis was detected in 13 of 518 patients (2.5%). Another 4 patients subsequently developed symptomatic proximal deep venous thrombosis, and 1 patient treated for asymptomatic deep venous thrombosis developed major bleeding, for a total outcome event rate of 1.0% (5 of 518 patients). In the placebo group, 3 patients developed symptomatic proximal deep venous thrombosis and 2 had nonfatal pulmonary embolism, for a total event rate of 1.0% (5 of 506 patients) (difference, 0 percentage points [95% CI, −1.2 to 1.2 percentage points]).

Conclusions: In patients undergoing total hip or knee arthroplasty, the use of warfarin prophylaxis during hospitalization results in a very low rate of symptomatic deep venous thrombosis or pulmonary embolism after hospital discharge. The use of screening compression ultrasonography at hospital discharge does not seem to be justified in this setting.


Grahic Jump Location
Figure 1.
Management allocations and outcomes of potentially eligible patients.
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