SLR - April 2010 - Simon McCoy
Reference:
Jameson, S.S., Bottle, A., Malviya, A., Muller, S.D., Reed, M.R. (2010). The impact of national guidelines for the prophylaxis of venous thromboembolism on the complications of arthroplasty of the lower limb. Journal of Bone & Joint Surgery (British), 92-B, 123-129.
Scientific Literature Reviews
Reviewed by: Simon McCoy, DPM
Residency Program: Botsford Hospital
Podiatric Relevance:
This study provides useful information about how the broad and indiscrete use of Low Molecular Weight Heparin (LMWH) for the prophylaxis for venous thromboembolism led to an actual increase in the incidence of both venous thromboembolism and thrombocytopenia.
Methods:
219,602 patients in a retrospective study from the national joint registry of England and Wales who all had either total knee replacement or total hip replacement surgery between 2005 and 2008. The 1st group of 104,640 had lower limb joint replacement before the enactment of the April 2007 recommendation that all patients be offered LMWH after lower limb joint replacements. The second group of 114,962 was from a time period after the implementation of the recommendation. The two groups were then evaluated for the overall incidence of venous thromboembolic events and thrombocytopenia following the lower limb arthroplasty. The rates in the two periods were compared using a Chi Square test.
Results:
The overall incidence of venous thromboembolism following an arthroplasty in the lower limb rose from 1.85% to 1.94% and was highest for total hip replacements. The rate of thrombocytopenia secondary to anticoagulant use increased from 0.11% to 0.14% while data from the National Joint Registry shows an increase in the use of LMWH for both the total knee and total hip replacement surgeries during that same time period.
Conclusions:
On the basis of these findings, the broad use of LWMH on patients undergoing lower extremity arthroplasty surgeries appears to have no overall benefit in the reduction of venous thromboembolism. Furthermore, the increase in the incidence of thrombocytopenia may be an unintended sequela.