Staged venous thromboemolic events prophylaxis with low-molecular-weight heparin followed by aspirin is safe and effective after arthroplasty.

BACKGROUND: The rate of fatal pulmonary embolism (PE) following hip and knee arthroplasty has remained unchanged despite the use of low-molecular-weight heparin (LMWH) and oral antithrombotic agents. Concerns regarding bleeding and wound complications resulted in the introduction of a staged chemoprophylaxis protocol at our institution in 2002. We hypothesized that staged chemoprophylaxis using LMWH in hospital followed by aspirin after discharge was safe and effective for the prevention of venous thromboembolic events (VTE). METHODS: Data were retrospectively collected on all patients undergoing hip and knee arthroplasty between 2002 and 2012. For VTE prophylaxis, LMWH was administered to all patients following surgery until discharge. Aspirin was prescribed from discharge until 6 weeks following surgery. Complications were recorded in a database. Patients suspected of having a VTE were investigated with bilateral lower limb duplex ultrasound and computerized tomography-pulmonary angiogram. RESULTS: The 11-year results of this protocol used in 9035 patients with a mean age 62 years (range 20-95) and follow-up at 6 weeks demonstrate an overall symptomatic VTE rate of 2.55% and overall PE rate of 1.28%. The overall fatal PE rate is 0.03% (unicompartmental knee arthroplasty 0.07-0.96%, total knee arthroplasty 0.19% and total hip arthroplasty 0%) and the all-cause mortality is 0.07%. The wound complication rate is low. CONCLUSION: Staged chemoprophylaxis using LMWH followed by aspirin is a safe and effective thromboprophylactic regime that is associated with a very low rate of fatal PE and all-cause mortality.