Abstract
The authors compare the frequency of thromboembolic disease in the patients receiving prophylactic therapy for 10 days or 35 days after total hip arthroplasty. The first group comprised 478 patients who received enoxaparin 10 days after surgery.
The other group included 289 patients when enoxaparin was administered either for the whole time (6,9 %), or for 10 days followed by warfarin up to the 35th postoperative day (93,1 %). In the first group thromboembolic disease developed in 23 patients (4,8 %) within 3 months after surgery (median 31st postoperative day), 6 patients had pulmonary embolism of which two of them died.
In the other group thromboembolic disease developed in 3 patients (1 %), 1 patient had pulmonary embolism with nonfatal outcome. However, complications associated with prophylactic treatment with warfarin were recorded in 52 patients (18 %): in 35 patients (12,1 %) it was difficult to establish the correct dosage of warfarin, in 13 patients (4,5 %) warfarin caused minor bleeding or dyspepsia and in 4 patients (1,4 %) major bleeding.
The prolonged prophylaxis of thromboembolic disease after total hip arthroplasty significantly reduce risk of this complication. The use of warfarin for this prophylaxis should be carefully considered, because its optimal dose is difficult to establish and its overdose may cause serious complications.