Seminars in Arthroplasty
Volume 20, Issue 4 , Pages 241-250 , December 2009

The Multimodal Approach for the Prevention of Thromboembolic Disease After Total Joint Arthroplasty

  • Alejandro González Della Valle, MD

      Affiliations

    • Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
    • Weill Medical College of Cornell University, New York, NY, USA
    • Corresponding Author InformationAddress reprint requests to Alejandro González Della Valle, MD, Hospital for Special Surgery, 535 East 70th St, New York, NY 10,021
  • ,
  • Francis Jeshira Reynoso, MD

      Affiliations

    • Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
  • ,
  • Judith Ben Ari, MD

      Affiliations

    • Woodhull Medical Center, Brooklyn, NY, USA
  • ,
  • Eduardo Salvati, MD

      Affiliations

    • Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
    • Weill Medical College of Cornell University, New York, NY, USA

References 

  1. Johnson R, Green JR, Charnley J. Pulmonary embolism and its prophylaxis following the Charnley total hip replacement. Clin Orthop Relat Res. 1977;127:123–132
  2. Coventry MB, Beckenbaugh RD, Nolan DR, et al. 2,012 total hip arthroplasties: A study of postoperative course and early complications. J Bone Joint Surg Am. 1974;56:273–284
  3. DiGiovanni CW, Restrepo A, González Della Valle AG, et al. The safety and efficacy of intraoperative heparin in total hip arthroplasty. Clin Orthop Relat Res. 2000;379:178–185
  4. Salvati EA, González Della Valle A. Thromboembolism following total hip replacement. J Long Term Eff Med Implants. 2003;13:325–340
  5. Salvati E, Sharrock NE, Westrich G, et al. Nicholas Andry award: Three decades of clinical, basic and applied research on thromboembolic disease after total hip arthroplasty (The rationale and clinical results of a multimodal prophylaxis protocol). Clin Orthop Relat Res. 2007;459:246–254
  6. Mohr DN, Silverstein MD, Ilstrup DM, et al. Venous thromboembolism associated with hip and knee arthroplasty: Current prophylactic practices and outcomes. Mayo Clin Proc. 1992;67:861–870
  7. Warwick D, Williams MH, Bannister GC. Death and thromboembolic disease after total hip replacement (A series of 1162 cases with no routine chemical prophylaxis). J Bone Joint Surg Br. 1995;77:6–10
  8. Lieberman JR, Wollaeger J, Dorey F, et al. The efficacy of prophylaxis with low-dose warfarin for prevention of pulmonary embolism following total hip arthroplasty. J Bone Joint Surg Am. 1997;79:319–325
  9. Westrich GH, Farrell C, Bono JV, et al. The incidence of venous thromboembolism after total hip arthroplasty: A specific hypotensive epidural anesthesia protocol. J Arthroplasty. 1999;14:456–463
  10. Sarmiento A, Goswami AD. Thromboembolic prophylaxis with use of aspirin, exercise, and graded elastic stockings or intermittent compression devices in patients managed with total hip arthroplasty. J Bone Joint Surg Am. 1999;81:339–346
  11. Salvati EA, Pellegrini VD, Sharrock NE, et al. Recent advances in venous thromboembolic prophylaxis during and after total hip replacement. J Bone Joint Surg Am. 2000;82:252–270
  12. Phillips CB, Barrett JA, Losina E, et al. Incidence rates of dislocation, pulmonary embolism, and deep infection during the first six months after elective total hip replacement. J Bone Joint Surg Am. 2003;85-A:20–26
  13. González Della Valle A, Serota A, Sorriaux G, et al. Venous thromboembolism is rare after total hip arthroplasty with a multimodal prophylaxis protocol. Clin Orthop Relat Res. 2006;443:146–153
  14. Murray DW, Carr AJ, Bulstrode CJ. Pharmacological thromboprophylaxis and total hip replacement. J Bone Joint Surg Br. 1995;77:3–5
  15. Warwick DJ, Whitehouse S. Symptomatic venous thromboembolism after total knee replacement. J Bone Joint Surg Br. 1997;79:780–786
  16. Cusick LA, Beverland DE. The incidence of fatal pulmonary embolism after primary hip and knee replacement in a consecutive series of 4253 patients. J Bone Joint Surg Br. 2009;91:645–648
  17. Sachs RA, Smith JH, Kuney M, et al. Does anticoagulation do more harm than good?: (A comparison of patients treated without prophylaxis and patients treated with low-dose warfarin after total knee arthroplasty). J Arthroplasty. 2003;18:389–395
  18. Salvati EA, Sharrock NE, Westrich G, et al. The 2007 ABJS Nicolas Andry award: Three decades of clinical, basic, and applied research on thromboembolic disease after THA: Rationale and clinical results of a multimodal prophylaxis protocol. Clin Orthop Relat Res. 2007;459:246–254
  19. Sharrock NE, González Della Valle A, Go G, et al. Potent anticoagulants are associated with a higher all-cause mortality rate after hip and knee arthroplasty. Clin Orthop Relat Res. 2008;466:714–721
  20. Sharrock NE, González Della Valle A, Go G, et al. Reply to letter to editor: Potent anticoagulants are associated with a higher all-cause mortality rate after hip and knee arthroplasty. Clin Orthop Relat Res. 2008;466:2012–2014
  21. Beksac B, González Della Valle A, Salvati EA. Thromboembolic disease after total hip arthroplasty: Who is at risk?. Clin Orthop Relat Res. 2006;453:211–224
  22. Bae H, Westrich GH, Sculco TP, et al. The effect of preoperative donation of autologous blood on deep-vein thrombosis after total hip arthroplasty. J Bone Joint Surg Br. 2001;83:676–679
  23. Sharrock NE, Fischer G, Goss S, et al. The early recovery of cognitive function after total-hip replacement under hypotensive epidural anesthesia. Reg Anesth Pain Med. 2005;30:123–127
  24. Modig J. Beneficial effects on intraoperative and postoperative blood loss in total hip replacement when performed under lumbar epidural anesthesia: An explanatory study. Acta Chir Scand. 1989;550(suppl):95–100discussion 100-103
  25. Davis FM, Laurenson VG, Gillespie WJ, et al. Deep vein thrombosis after total hip replacement: A comparison between spinal and general anaesthesia. J Bone Joint Surg Br. 1989;71:181–185
  26. Modig J, Borg T, Karlstrom G, et al. Thromboembolism after total hip replacement: Role of epidural and general anesthesia. Anesth Analg. 1983;62:174–180
  27. Wille-Jørgensen P, Christensen SW, Bjerg-Nielsen A, et al. Prevention of thromboembolism following elective hip surgery (The value of regional anesthesia and graded compression stockings). Clin Orthop Relat Res. 1989;247:163–167
  28. Prins MH, Hirsh J. A comparison of general anesthesia and regional anesthesia as a risk factor for deep vein thrombosis following hip surgery: A critical review. Thromb Haemost. 1990;64:497–500
  29. Sharrock NE, Salvati EA. Hypotensive epidural anesthesia for total hip arthroplasty: A review. Acta Orthop Scand. 1996;67:91–107
  30. Sharrock NE, Cazan MG, Hargett MJ, et al. Changes in mortality after total hip and knee arthroplasty over a ten-year period. Anesth Analg. 1995;80:242–248
  31. Sharrock NE, Mineo R, Urquhart B, et al. The effect of two levels of hypotension on intraoperative blood loss during total hip arthroplasty performed under lumbar epidural anesthesia. Anesth Analg. 1993;76:580–584
  32. Sharrock NE, Go G, Harpel PC, et al. The John Charnley award (Thrombogenesis during total hip arthroplasty). Clin Orthop Relat Res. 1995;319:16–27
  33. Pitto RP, Koessler M, Draenert K. The John Charnley award (Prophylaxis of fat and bone marrow embolism in cemented total hip arthroplasty). Clin Orthop Relat Res. 1998;355:23–34
  34. Sharrock N, Go G, Mayman D, et al. Decreases in pulmonary artery oxygen saturation during total hip arthroplasty (Variations using two leg positioning techniques). J Arthroplasty. 2005;20:499–502
  35. Hooker JA, Lachiewicz PF, Kelley SS. Efficacy of prophylaxis against thromboembolism with intermittent pneumatic compression after primary and revision total hip arthroplasty. J Bone Joint Surg Am. 1999;81:690–696
  36. Macaulay W, Westrich G, Sharrock N, et al. Effect of pneumatic compression on fibrinolysis after total hip arthroplasty. Clin Orthop Relat Res. 2002;399:168–176
  37. Ryan MG, Westrich GH, Potter HG, et al. Effect of mechanical compression on the prevalence of proximal deep venous thrombosis as assessed by magnetic resonance venography. J Bone Joint Surg Am A. 2002;84:1998–2004
  38. Westrich GH, Specht LM, Sharrock NE, et al. Pneumatic compression hemodynamics in total hip arthroplasty. Clin Orthop Relat Res. 2000;372:180–191
  39. Markel DC, Urquhart B, Derkowska I, et al. Effect of epidural analgesia on venous blood flow after hip arthroplasty. Clin Orthop Relat Res. 1997;334:168–174
  40. Prandoni P, Lensing AW, Prins MH, et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: A randomized, controlled trial. Ann Intern Med. 2004;141:249–256
  41. Butt AJ, McCarthy T, Kelly IP, et al. Sciatic nerve palsy secondary to postoperative haematoma in primary total hip replacement. J Bone Joint Surg Br B. 2005;87:1465–1467
  42. Callaghan JJ, Dorr LD, Engh GA, et al. Prophylaxis for thromboembolic disease. J Arthroplasty. 2005;20:273–274
  43. Freedman KB, Brookenthal KR, Fitzgerald RH, et al. A meta-analysis of thromboembolic prophylaxis following elective total hip arthroplasty. J Bone Joint Surg Am A. 2000;82:929–938
  44. Friedman RJ, Dunsworth GA. Cost analyses of extended prophylaxis with enoxaparin after hip arthroplasty. Clin Orthop Relat Res. 2000;370:171–182
  45. Imperiale TF, Speroff T. A meta-analysis of methods to prevent venous thromboembolism following total hip replacement. JAMA. 1994;271:1780–1785
  46. Salvati EA, Sharrock NE, González Della Valle A. Current concepts in the pathogenesis, diagnosis and multimodal prophylaxis of thromboembolism disease following total hip replacement. Minerva Ortopedicae Traumatologica. 2003;54:381–401
  47. Shaieb MD, Watson BN, Atkinson RE. Bleeding complications with enoxaparin for deep venous thrombosis prophylaxis. J Arthroplasty. 1999;14:432–438
  48. Beksac BP, González Della Valle A, Salvati EA. Acute sciatic nerve palsy as a delayed complication of low-molecular-weight heparin prophylaxis after total hip arthroplasty. Am J Orthop. 2009;38:E28–E30
  49. Colwell CW, Berkowitz SD, Lieberman JR, et al. Oral direct thrombin inhibitor ximelagatran compared with warfarin for the prevention of venous thromboembolism after total knee arthroplasty. J Bone Joint Surg Am. 2005;87:2169–2177
  50. Dearborn JT, Harris WH. Postoperative mortality after total hip arthroplasty (An analysis of deaths after two thousand seven hundred and thirty-six procedures). J Bone Joint Surg Am. 1998;80:1291–1294
  51. Pellegrini VD, Donaldson CT, Farber DC, et al. The John Charnley Award: Prevention of readmission for venous thromboembolic disease after total hip arthroplasty. Clin Orthop Relat Res. 2005;441:56–62
  52. Planes A, Samama MM, Lensing AW, et al. Prevention of deep vein thrombosis after hip replacement—Comparison between two low-molecular heparins, tinzaparin and enoxaparin. Thromb Haemost. 1999;81:22–25
  53. Lachiewicz PF, Kelley SS, Haden LR. Two mechanical devices for prophylaxis of thromboembolism after total knee arthroplasty: A prospective, randomised study. J Bone Joint Surg Br. 2004;86:1137–1141
  54. Mantilla CB, Horlocker TT, Schroeder DR, et al. Risk factors for clinically relevant pulmonary embolism and deep venous thrombosis in patients undergoing primary hip or knee arthroplasty. Anesthesiology. 2003;99:552–560discussion 5A
  55. Memtsoudis SG, Besculides MC, Gaber L, et al: Risk factors for pulmonary embolism after hip and knee arthroplasty: A population-based study. Int Orthop (in press)
  56. Lieberman JR. Venous thromboembolism after total hip arthroplasty. In:  Callaghan JJ,  Rosenberg AG,  Rubash HE editor. The Adult Hip. Philadelphia, PA: Lippincot-Raven; 1998;p. 633–646
  57. Mantilla CB, Horlocker TT, Schroeder DR, et al. Frequency of myocardial infarction, pulmonary embolism, deep venous thrombosis, and death following primary hip or knee arthroplasty. Anesthesiology. 2002;96:1140–1146
  58. Salvati EA, González Della Valle A, Westrich GH, et al. The John Charnley Award: Heritable thrombophilia and development of thromboembolic disease after total hip arthroplasty. Clin Orthop Relat Res. 2005;441:40–55
  59. Ferrari B, Baudouy M, Cerboni P. Clinical epidemiology of venous thromboembolic disease (Results of a French multicenter registry). Eur Heart J. 1997;18:681–691
  60. Miles JS, Miletich JP, Goldhaber SZ, et al. G20210A mutation in the prothrombin gene and the risk of recurrent venous thromboembolism. J Am Coll Cardiol. 2001;37:215–218
  61. Pabinger I, Grafenhofer H, Kaider A, et al. Preeclampsia and fetal loss in women with a history of venous thromboembolism. Arterioscler Thromb Vasc Biol. 2001;21:874–879
  62. Westrich GH, Weksler BB, Glueck CJ, et al. Correlation of thrombophilia and hypofibrinolysis with pulmonary embolism following total hip arthroplasty: An analysis of genetic factors. J Bone Joint Surg Am. 2002;84-A:2161–2167
  63. Gomes MPV, Deitcher SR. Risk of venous thromboembolic disease associated with hormonal contraceptives and hormone replacement therapy: A clinical review. Arch Intern Med. 2004;164:1965–1976
  64. Rosendaal FR, Helmerhorst FM, Vandenbroucke JP. Female hormones and thrombosis. Arterioscler Thromb Vasc Biol. 2002;22:201–210
  65. Beksac B, González Della Valle A, Anderson J, et al. Symptomatic thromboembolism after one-stage bilateral THA with a multimodal prophylaxis protocol. Clin Orthop Relat Res. 2007;463:114–119
  66. Sculco TP, Ranawat C. The use of spinal anesthesia for total hip-replacement arthroplasty. J Bone Joint Surg Am. 1975;57:173–177
  67. Sharrock NE, Go G, Williams-Russo P, et al. Comparison of extradural and general anaesthesia on the fibrinolytic response to total knee arthroplasty. Br J Anaesth. 1997;79:29–34
  68. Sharrock NE, Mineo R, Go G. The effect of cardiac output on intraoperative blood loss during total hip arthroplasty. Reg Anesth. 1993;18:24–29
  69. Brooks PJ, Keramati M, Wickline A. Thromboembolism in patients undergoing total knee arthroplasty with epidural analgesia. J Arthroplasty. 2007;22:641–643
  70. Bading B, Blank SG, Sculco TP, et al. Augmentation of calf blood flow by epinephrine infusion during lumbar epidural anesthesia. Anesth Analg. 1994;78:1119–1124
  71. Mineo R, Sharrock NE. Pulse oximeter waveforms from the finger and toe during lumbar epidural anesthesia. Reg Anesth. 1993;18:106–109
  72. Sharrock NE, Ranawat CS, Urquhart B, et al. Factors influencing deep vein thrombosis following total hip arthroplasty under epidural anesthesia. Anesth Analg. 1993;76:765–771
  73. Sharrock NE, Beksac B, Flynn E, et al. Hypotensive epidural anaesthesia in patients with preoperative renal dysfunction undergoing total hip replacement. Br J Anaesth. 2006;96:207–212
  74. Williams-Russo P, Sharrock NE, Mattis S, et al. Cognitive effects after epidural vs general anesthesia in older adults: A randomized trial. JAMA. 1995;274:44–50
  75. Gitel SN, Salvati EA, Wessler S, et al. The effect of total hip replacement and general surgery on antithrombin III in relation to venous thrombosis. J Bone Joint Surg Am. 1979;61:653–656
  76. Huo MH, Salvati EA, Sharrock NE, et al. Intraoperative adjusted-dose heparin thromboembolic prophylaxis in primary total hip arthroplasty. Clin Orthop Relat Res. 1992;277:188–196
  77. Huo MH, Salvati EA, Sharrock NE, et al. Intraoperative heparin thromboembolic prophylaxis in primary total hip arthroplasty: A prospective, randomized, controlled, clinical trial. Clin Orthop Relat Res. 1992;274:35–46
  78. Sharrock NE, Brien WW, Salvati EA, et al. The effect of intravenous fixed-dose heparin during total hip arthroplasty on the incidence of deep-vein thrombosis (A randomized, double-blind trial in patients operated on with epidural anesthesia and controlled hypotension). J Bone Joint Surg Am. 1990;72:1456–1461
  79. Dahl OE. The role of the pulmonary circulation in the regulation of coagulation and fibrinolysis in relation to major surgery. J Cardiothorac Vasc Anesth. 1997;11:322–328
  80. Binns M, Pho R. Femoral vein occlusion during hip arthroplasty. Clin Orthop Relat Res. 1990;255:168–172
  81. Planes A, Vochelle N, Fagola M. Total hip replacement and deep vein thrombosis: A venographic and necropsy study. J Bone Joint Surg Br. 1990;72:9–13
  82. Stamatakis JD, Kakkar VV, Sagar S, et al. Femoral vein thrombosis and total hip replacement. BMJ. 1977;2:223–225
  83. Sharrock NE, Go G, Sculco TP, et al. Dose response of intravenous heparin on markers of thrombosis during primary total hip replacement. Anesthesiology. 1999;90:981–987
  84. Westrich GH, Salvati EA, Sharrock N, et al. The effect of intraoperative heparin administered during total hip arthroplasty on the incidence of proximal deep vein thrombosis assessed by magnetic resonance venography. J Arthroplasty. 2005;20:42–50
  85. Christie J, Robinson CM, Singer B, et al. Medullary lavage reduces embolic phenomena and cardiopulmonary changes during cemented hemiarthroplasty. J Bone Joint Surg Br. 1995;77:456–459
  86. Pitto RP, Hamer H, Fabiani R, et al. Prophylaxis against fat and bone-marrow embolism during total hip arthroplasty reduces the incidence of postoperative deep-vein thrombosis: A controlled, randomized clinical trial. J Bone Joint Surg Am A. 2002;84:39–48
  87. Bishop NE, Ferguson S, Tepic S. Porosity reduction in bone cement at the cement-stem interface. J Bone Joint Surg Br. 1996;78:349–356
  88. Dall DM, Miles AW, Juby G. Accelerated polymerization of acrylic bone cement using preheated implants. Clin Orthop. 1986;211:148–150
  89. Iesaka K, Jaffe WL, Kummer FJ. Effects of preheating of hip prostheses on the stem-cement interface. J Bone Joint Surg Am A. 2003;85:421–427
  90. Parks ML, Walsh HA, Salvati EA, et al. Effect of increasing temperature on the properties of four bone cements. Clin Orthop Relat Res. 1998;355:238–248
  91. Block BM, Liu SS, Rowlingson AJ, et al. Efficacy of postoperative epidural analgesia: A meta-analysis. JAMA. 2003;290:2455–2463
  92. Viscusi ER, Martin G, Hartrick CT, et al. Forty-eight hours of postoperative pain relief after total hip arthroplasty with a novel, extended-release epidural morphine formulation. Anesthesiology. 2005;102:1014–1022
  93. Barnes RW, Brand RA, Clarke W, et al. Efficacy of graded-compression antiembolism stockings in patients undergoing total hip arthroplasty. Clin Orthop. 1978;132:61–67
  94. Pagnani MJ, Pellicci PM, Salvati EA. Effect of aspirin on heterotopic ossification after total hip arthroplasty in men who have osteoarthrosis. J Bone Joint Surg Am. 1991;73:924–929
  95. Bek D, Beksac B, González Della Valle A, et al. Aspirin decreases the prevalence and severity of heterotopic ossification after 1-stage bilateral total hip arthroplasty for osteoarthrosis. J Arthroplasty. 2009;24:226–232
  96. Shepard M, Mills C. Fatal pulmonary embolism following hip and knee replacement (A study of 2153 cases using routine mechanical prophylaxis and selective chemoprophylaxis). Hip Int. 2006;16:53–56
  97. Blom A, Pattison G, Whitehouse S, et al. Early death following primary total hip arthroplasty: 1,727 procedures with mechanical thrombo-prophylaxis. Acta Orthop. 2006;77:347–350
  98. D'Andrea G, D'Ambrosio RL, Di Perna P, et al. A polymorphism in the VKORC1 gene is associated with an interindividual variability in the dose-anticoagulant effect of warfarin. Blood. 2005;105:645–649
  99. Kohnke H, Sorlin K, Granath G, et al. Warfarin dose related to apolipoprotein E (APOE) genotype. Eur J Clin Pharmacol. 2005;61:381–388
  100. Kosaki K, Yamaghishi C, Sato R, et al. 1173C> T polymorphism in VKORC1 modulates the required warfarin dose. Pediatr Cardiol. 2006;27:685–688
  101. Salvati EA, Lachiewicz P. Thromboembolism following total hip-replacement arthroplasty (The efficacy of dextran-aspirin and dextran-warfarin in prophylaxis). J Bone Joint Surg Am. 1976;58:921–925
  102. González Della Valle A, Ruzo PS, Salvati EA. Warfarin-associated intracapsular hemorrhage causing an acutely painful total hip arthroplasty: A rare complication of prolonged anticoagulant therapy. J Arthroplasty. 2000;15:668–670
  103. Rosove MH, Grody WW. Should we be applying warfarin pharmacogenetics to clinical practice? (No, not now). Ann Intern Med. 2009;151:270–273W95
  104. Warkentin TE, Greinacher A. Heparin-induced thrombocytopenia: Recognition, treatment, and prevention: The seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2004;126(suppl):311S–337S
  105. Hann CL, Streiff MB. The role of vena caval filters in the management of venous thromboembolism. Blood Rev. 2005;19:179–202
  106. The PREPIC Study Group. Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: The PREPIC (prevention du risque d'embolie pulmonaire par interruption cave) randomized study. Circulation. 2005;112:416–422
  107. Francis CW, Berkowitz SD, Comp PC, et al. Comparison of ximelagatran with warfarin for the prevention of venous thromboembolism after total knee replacement. N Engl J Med. 2003;349:1703–1712
  108. Colwell CW, Collis DK, Paulson R, et al. Comparison of enoxaparin and warfarin for the prevention of venous thromboembolic disease after total hip arthroplasty: Evaluation during hospitalization and three months after discharge. J Bone Joint Surg Am. 1999;81:932–940
  109. Hull R, Raskob G, Pineo G, et al. A comparison of subcutaneous low-molecular-weight heparin with warfarin sodium for prophylaxis against deep-vein thrombosis after hip or knee implantation. N Engl J Med. 1993;329:1370–1376
  110. Hull RD, Pineo GF, Francis C, et al. Low-molecular-weight heparin prophylaxis using dalteparin in close proximity to surgery vs warfarin in hip arthroplasty patients: A double-blind, randomized comparison (The North American Fragmin Trial Investigators). Arch Intern Med. 2000;160:2199–2207
  111. Hull RD, Pineo GF, Stein PD, et al. Timing of initial administration of low-molecular-weight heparin prophylaxis against deep vein thrombosis in patients following elective hip arthroplasty: A systematic review. Arch Intern Med. 2001;161:1952–1960
  112. Lilikakis AK, Papapolychroniou T, Macheras G, et al. Thrombocytopenia and intra-cerebral complications associated with low-molecular-weight heparin treatment in patients undergoing total hip replacement: A report of two cases. J Bone Joint Surg Am. 2006;88:634–638
  113. Sanchez-Ballester J, Smith M, Hassan K, et al. Wound infection in the management of hip fractures: A comparison between low-molecular weight heparin and mechanical prophylaxis. Acta Orthop Belg. 2005;71:55–59
  114. Burnett RS, Clohisy JC, Wright RW, et al. Failure of the American College of Chest Physicians-1A protocol for lovenox in clinical outcomes for thromboembolic prophylaxis. J Arthroplasty. 2007;22:317–324
  115. Patel VP, Walsh M, Sehgal B, et al. Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty. J Bone Joint Surg Am. 2007;89:33–38
  116. Lieberman JR, Huo MM, Hanway J, et al. The prevalence of deep venous thrombosis after total hip arthroplasty with hypotensive epidural anesthesia. J Bone Joint Surg Am. 1994;76:341–348
  117. Leclerc JR, Gent M, Hirsh J, et al. The incidence of symptomatic venous thromboembolism after enoxaparin prophylaxis in lower extremity arthroplasty: A cohort study of 1,984 patients (Canadian Collaborative Group). Chest. 1998;114(suppl 2 Evidence):115S–118S
  118. Lotke PA, Palevsky H, Keenan AM, et al. Aspirin and warfarin for thromboembolic disease after total joint arthroplasty. Clin Orthop Relat Res. 1996;324:251–258
  119. Warwick D, Harrison J, Glew D, et al. Comparison of the use of a foot pump with the use of low-molecular-weight heparin for the prevention of deep-vein thrombosis after total hip replacement: A prospective, randomized trial. J Bone Joint Surg Am. 1998;80:1158–1166
  120. Parry M, Wylde V, Blom AW. Ninety-day mortality after elective total hip replacement: 1549 patients using aspirin as a thromboprophylactic agent. J Bone Joint Surg Br. 2008;90:306–307
  121. Bozic KJ, Vail TP, Pekow PS, et al: Does aspirin have a role in venous thromboembolism prophylaxis in total knee arthroplasty patients? J Arthroplasty (in press)
  122. Virchow R. Neuer fall von todlicher emboli der lungenarterie. Arch Pathol Anat. 1856;10:225–228

PII: S1045-4527(09)00060-1

doi: 10.1053/j.sart.2009.10.008

Seminars in Arthroplasty
Volume 20, Issue 4 , Pages 241-250 , December 2009