THROMBOEMBOLIC PROPHYLAXIS WITH USE...

THROMBOEMBOLIC PROPHYLAXIS WITH USE OF ASPIRIN, EXERCISE, AND GRADED ELASTIC STOCKINGS OR INTERMITTENT COMPRESSION DEVICES IN PATIENTS MANAGED WITH TOTAL HIP ARTHOPLASTY A s Sarmiento, C Gables, A D K Goswami Journal of Bone and Joint Surgery Vol 81 (March 1999) 339-346

hard venous thrombosis (DVT) is the primary source of pulmonary embolism (PE) and a well-known risk associated with total hip arthroplasty. Generally, either pharmacologic, mechanical, or a combination of modes of DVT prophylaxis are used to obstruct this complication. The purpose of this cohort retrospective thought was to determine the rates of fatal pulmonary embolism, nonfatal pulmonary embolism, and clinically symptomatic DVT in a dispose of patients receiving a prophylaxis consisting of aspirin, intraoperative and postoperative exercises, and graded elastic stockings or intermittent compression devices.

way s The study consisted of 1267 patients who underwent 1492 total hip arthroplasties (1313 primary and 179 revision procedures) Of the conducts 774 (51.9%) were performed in Miami, and 718 (481%) were performed in beholds Angeles. The average hospital stay was seven days. Of the arthroplasties, 865 (58%) were performed forward women, and 627 (42%) were performed in succession men. The average age of the patient at the time of surgery was 63 years. Patients were tracked for a minimum of three month Epidural anesthesia was used for 1099 (737%) manner of proceedings and general anesthesia was used for 393 (263%) measures During the surgeries, surgical team members were instructed to avoid of the rarest kind flexion and internal rotation of the hip and knee and to carry abroad passive exercises of the hip, knee and ankle to avoid damage to the intimal layer of the popliteal and femoral vessels

Graded elastic stockings were applied postoperatively in succession 774 (51.9%) patients, and intermittent compression devices were applied forward 718 (48.1%) patients. Walking began in succession postoperative day one. Active isometric and isotonic exercises were performed for sum of two units minutes at 15-minute intervals during the immediate postoperative period. Patients received a 600 mg aspirin suppository postoperatively and continued to receive 325 mg of aspirin by means of mouth, twice per day, until discharged.

Clinical diagnosis of DVT was made when at least single in kind symptom was present (eg, tendernes of the calf or inner thigh; leg ankle, or base edema; positive Homans sign; slight elevation of temperature). Diagnosis of PE was established based in succession clinical findings, blood gas determination, suggestive changes upon chest x-rays, and electrocardiograph findings.

accrues Fatal PE occurred in brace (.013%)patients. Clinically evident PE occurr in 14 (094%) patients. The diagnosis of DVT occurr in 15 (1%) patients, including six who wore graded elastic stockings and nine who wore intermittent compression devices. Statistically, there was no difference ([Xsub2] = 085; P [is greater than] 05) between the couple mechanical methods of treatment. No correlation was noted between geographic locations and the exhibition of DVT or PE. A significant difference was noted between those patients who received epidural anesthesia and general anesthesia in the adventure of nonfatal PE (P [is les than] 001) and DVT (P [is les than] 025) No significant difference was plant between the use of elastic stockings and intermittent compression devices in the prevention of thromboembolic complications.

Discussion. cheap molecular-weight heparin and warfarin have been lay the foundation of to be more effective in the prevention of DVT than other [i]modus operandi[/i]s These chemical modalities, however, outcome in a clinically higher rate of bleeding.

Increasing numbers of family are taking aspirin as a prophylaxis against coronary disease. In this research researchers did not know to what extent many patients had taken aspirin before their surgery and, therefore, were unable to determine the most numerous effective dosage of aspirin that should be administered as a prophylaxis against DVT

It has been hinted but never documented in the literature, that there may be a geographic difference in the prevalence of thromboembolic disease. No significant difference was noted in this study

Perioperative Implications.

The findings of this research suggest that an inexpensive protocol of aspirin, exercise, and the use of graded elastic stockings or intermittent compression devices is associated with reduc postoperative thromboembolic complications. Researchers did not indicate whether the mechanical classifications used were thigh- or knee-high in amplification Many hospitals are beginning to evaluate the use of non-pharmacologic prophylaxis for thromboembolism. Based onward the findings of this meditation it is suggested that the choice of graded elastic stockings or intermittent compression devices may increase patient comfort and compliance and also achieve a costliness savings.

CECIL A. KING RN M CNOR, CN NURSING RESEARCH COMMITTEE

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