Initiating versus delaying treatment-dose anticoagulation in suspected venous thromboembolism (VTE) in post-operative hip and knee arthroplasty patients: Outcomes and risks.

Menon, D.; Moran, E.; Ejiofor, I.; van Duren, B.; Pandit, H.

Initiating versus delaying treatment-dose anticoagulation in suspected venous thromboembolism (VTE) in post-operative hip and knee arthroplasty patients: Outcomes and risks.

All Authors

Menon, D.

Moran, E.

Ejiofor, I.

van Duren, B.

Pandit, H.

LTHT Author

Menon, Deepak
Moran, Emma
Ejiofor, Ikechukwu
Van Duren, Bernard
Pandit, Hemant

LTHT Department

Orthopaedics

Publication Date

2024

Item Type

Journal Article

Abstract

Background: Hip and knee arthroplasty is a risk factor for venous thromboembolism (VTE). Initiation of treatment-dose anticoagulation in the post-operative period in suspected cases prior to confirmed diagnosis involves balancing increased bleeding risk to VTE-associated morbidity. Methods: A single-centre retrospective cohort study was undertaken comparing outcomes of empirical treatment of suspected VTE in post-operative elective lower-limb arthroplasty patients as opposed to delaying treatment until diagnosis is confirmed. All patients undergoing ultrasonography (US) or CT-pulmonary-angiogram (CTPA) for suspected VTE following elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) between 05/05/17 and 19/07/21 were identified. Primary outcomes were surgical site infection (SSI), readmission, and other wound problems within 30-days of surgery. Results: 107 patients were included for analysis. 93 patients had suspected deep venous thrombosis (DVT), 21 had suspected pulmonary embolism (PE), and 7 were investigated for both DVT and PE. Empirical treatment-dose anticoagulation was initiated in 4 patients with suspected pulmonary embolism (PE) prior to CTPA, and 34 patients with suspected deep venous thrombosis (DVT) prior to US. No significant differences were noted in 30-day readmission rate ([DVT: 12 % vs 23 %, p = 0.41], [PE: 50 % vs 33 %, p = 1.00]), SSI rate ([DVT: 6 % vs 3 %, p = 1.00], [PE: 0 % vs 11 %, p = 1.00]) or other wound complication rate ([DVT: 3 % vs 3 %, p = 1.00), [PE 0 % vs 11 %, p = 1.00]) between empirically and non-empirically treated groups respectively. Conclusion: Empirical initiation of therapeutic anticoagulation in post-operative lower limb arthroplasty patients with suspected VTE appears to be safe practice prior to a definitive diagnosis.