Document Detail


Comprehensive deep venous thrombosis prevention strategy after total-knee arthroplasty.
MedLine Citation:
PMID:  12595766     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Venous thromboembolism after total-knee arthroplasty represents a common early postoperative complication resulting in significant morbidity. Despite this, the optimal prophylactic regimen is controversial. The prevalence of venous thromboembolism has been cited as high as 35% in patients receiving pharmacologic prevention alone. We investigated the efficacy of a comprehensive prevention protocol encompassing the use of epidural anesthesia, aspirin, venous foot compression pumps, and early mobilization in a series of consecutive total-knee arthroplasties. DESIGN: A series of 100 consecutive total-knee arthroplasty patients were enrolled into the prospective trial. All patients were allowed full weight bearing on the first postoperative day and ambulation as tolerated. Venous foot compression pumps and aspirin were used immediately after surgery in the totality of subjects. Seventy-five percent of the patients were transferred to an acute rehabilitation service during the first postoperative week. The presence of deep-vein thrombosis was subsequently determined with the routine use of venous duplex scans. RESULTS: Three patients (3%) demonstrated evidence of distal deep-vein thrombosis. No patient had symptomatic pulmonary embolism. CONCLUSION: The combination of epidural anesthesia, aspirin, immediate postoperative venous foot compression pumps, and early ambulation together seem to be a more effective approach to prevent the occurrence of thromboembolic events after knee replacements than pharmacologic prevention alone.
Authors:
Mark V Ragucci; Alex Leali; Alex Moroz; Joseph Fetto
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  American journal of physical medicine & rehabilitation / Association of Academic Physiatrists     Volume:  82     ISSN:  0894-9115     ISO Abbreviation:  Am J Phys Med Rehabil     Publication Date:  2003 Mar 
Date Detail:
Created Date:  2003-02-21     Completed Date:  2003-03-19     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8803677     Medline TA:  Am J Phys Med Rehabil     Country:  United States    
Other Details:
Languages:  eng     Pagination:  164-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Rehabilitation Medicine, New York University School of Medicine, New York 10016, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anesthesia, Epidural
Arthroplasty, Replacement, Knee / adverse effects*,  rehabilitation
Aspirin / therapeutic use
Bandages
Early Ambulation
Female
Humans
Male
Middle Aged
Platelet Aggregation Inhibitors / therapeutic use
Prospective Studies
Ultrasonography, Doppler, Duplex
Venous Thrombosis / etiology,  prevention & control*,  ultrasonography
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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