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DVT/PE Prophylaxis in THR

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- See strong>a href="/joints/hip/total-hip-arthroplasty/">Total Hip Replacement Menu:/a>/strong> br/>
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strong>- Discussion:/strong> (strong>a href="/ortho/deep_venous_thrombosis">general discussion of DVT/a>/strong>) br/>
    - 40-60% of THR patients who do not receive prophylaxis will get a DVT (dependment on imaging method); br/>
           - ref: Significance of deep venous thrombosis in the lower extremity after total joint arthroplasty. br/>
    - in contrast, the study by a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/9393900">Fender, et al/a> (1997) showed that the incidence of fatal PE (as diagnosed by postmortem examination) was 4 / 2111 patients (0.19%); br/>
           - in this study, use of chemical prophylactic agents had no impact on the occurance of a fatal PE (3 patients that died had been on br/>
                  chemical prophylactic agents and one patient died that had no prophylaxis); br/>
           - these authors feel that the issue can only be solved by a large scale prospective randomized trial (tens of thousands of patients); br/>
    - supporting this data, is the study by a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/7822397">Warwick, et al/a> which showed one fatal PE out of 1162 consecutive total hip replacements (death rate from PE was 0.34% ); br/>
            - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" ref="ordinalpos=3&ncbi_uid=9393900&link_uid=9393900&linksrc=docsum_title" href="http://www.ncbi.nlm.nih.gov/pubmed/9393900">Mortality and fatal pulmonary embolism after primary total hip replacement. Results from a regional hip register./a>br/>
            - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" ref="ordinalpos=4&ncbi_uid=7822397&link_uid=7822397&linksrc=docsum_title" href="http://www.ncbi.nlm.nih.gov/pubmed/7822397">Death and thromboembolic disease after total hip replacement. A series of 1162 cases with no routine chemical prophylaxis./a>br/>
    - strong>risks of rehospitalization:/strong> br/>
           - in the study by a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/11114314">White, et al/a> (2000) identified 297 patients 65 years of age or older who were br/>
                  rehospitalized for thromboembolism within 3 months after THR; br/>
                  - total of 89.6% with thromboembolism and 93.8 % of controls were treated w/ SCDs, warfarin, enoxaparin, or unfractionated heparin, alone or in combination; br/>
                  - 22.2 % and 29.7 %, respectively, received warfarin after discharge; br/>
                  - body-mass index (wt in kg divided by square of ht in meters) of 25 or greater was associated w/ rehospitalization for thromboembolism, w/ odds ratio of 2.5; br/>
                  - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/11114314">Predictors of Rehospitalization for Symptomatic Venous Thromboembolism after Total Hip Arthroplasty/a>.  br/>
                  - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/17006373">Thromboembolic Disease after Total Hip Arthroplasty: Who is at Risk?/a> br/>
    - strong>when is prophylaxis to be initiated?/strong> br/>
          - in the review article by a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/10682733">Salvati, et al/a>, the authors point out that timing of heparin administration may be critcal for DVT prophylaxis; br/>
               - they point out that thrombogenesis begins during the preparation of the femur and is most pronounced with implantation of femoral components br/>
                      with cement rather than without cement; br/>
                      - in this phase, thrombotic mediators are released which leads to femoral venous occlusion occurs; br/>
               - the authors recommend giving a bolus of IV heparin (approx 3000 units) just before cement preparation of the femur; br/>
               - because the half life of IV heparin is short (approx 30-40 min), risk of significant bleeding is minimal; br/>
               - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/10682733">Recent Advances in Venous Thromboembolic Prophylaxis During and After Total Hip Replacement/a>. br/>
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    - strong>how long should prophylaxis be given?/strong> br/>
          - in the report by a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/11263636">Comp PC, et al/a>, the authors evaluated the efficacy and safety of a prolonged post-hospital regimen of enoxaparin; br/>
               - following elective THR or TKR, 968 patients received subcutaneous enoxaparin (30 mg twice daily) for 7-10 days, and 873 were then randomized to receive br/>
                      three weeks of double-blind outpatient treatment with either enoxaparin (40 mg once daily) or a placebo; br/>
               - enoxaparin was superior to the placebo in reducing the prevalence of venous thromboembolism in patients treated with THR; br/>
               - 8.0% of patients treated with enoxaparin had DVT compared with 23.2% of patients treated with the placebo; br/>
               - enoxaparin had no significant benefit in the patients treated with knee replacement; br/>
               - 17.5% of the patients treated with enoxaparin had DVT compared with 46 20.8% of patients treated with the placebo; br/>
               - symptomatic PE developed in three patients, one with a hip replacement and two with a knee replacement, all had received the placebo; br/>
               - there was no significant difference in the prevalence of hemorrhagic episodes or other types of toxicity between the enoxaparin and placebo-treated groups; br/>
          - references: br/>
               - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" ref="linkpos=2&log$=citationsensor" href="http://www.ncbi.nlm.nih.gov/pubmed/11263636">Prolonged enoxaparin therapy to prevent venous thromboembolism after primary hip or knee replacement. Enoxaparin Clinical Trial Group./a>   br/>
               - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/17403806">The Cost-Effectiveness of Extended-Duration Antithrombotic Prophylaxis After Total Hip Arthroplasty./a> br/>
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strong>- Diagnostic Methods:/strong> br/>
    - references: br/>
          - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/2200790">B-mode ultrasound scanning in the detection of proximal venous thrombosis after total hip replacement/a>. br/>
          - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/1914293">Duplex scanning versus venography as a screening examination in total hip arthroplasty patients/a>. br/>
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strong>- Prophylactic Agents:/strong> br/>
    - strong>a href="/joints/hip/aspirin-bayer/">aspirin/a>:/strong> br/>
          - references: br/>
                 - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/2193114">Aspirin prophylaxis and surveillance of pulmonary embolism and deep vein thrombosis in total hip arthroplasty/a>. br/>
                 - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/15995432">Thromboembolic Disease Prophylaxis in Total Hip Arthroplasty/a>. br/>
    - strong>a href="/joints/hip/heparin/">heparin/a> and a href="/joints/hip/low-molecular-wt-heparins-enoxaparin-lovenox/">low molecular wt agents/a>:/strong> br/>
          - in THR, relative risk reduction for DVT using LMWHs is about 70%; br/>
          - even with use of low molecular wt heparins, the risk of DVT following THR may be as high as 15%; br/>
                 - ref: a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/10875427">Finding the right fit: Effective thrombosis risk stratification in orthopaedic patients/a>.  br/>
          - in a total hip arthroplasty study by a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/2254352">Colwell, et al/a> (1999), the overall rate of throboembolic disease was 3.6% for patients receiving br/>
                 lovenox versus 3.7 % for patients receiving adjusted dose coumadin; br/>
                 - lovenox (or coumadin) was continued only for the length of the primary hospitalization (which averaged 7 days; br/>
          - references: br/>
                 - a href="http://www.ncbi.nlm.nih.gov/pubmed/10428124" ref="ordinalpos=30&ncbi_uid=10428124&link_uid=10428124&linksrc=docsum_title">Comparison of enoxaparin and warfarin for the prevention of venous thromboembolic disease after total hip arthroplasty. Evaluation during hospitalization and three months after discharge./a>br/>
                 - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/3275673">Dihydroergotamine/heparin in the prevention of deep-vein thrombosis after total hip replacement. A controlled, prospective, randomized multicenter trial/a>br/>
                 - a class="title" onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" ref="linkpos=2&log$=citationsensor3&link_uid=2254352" href="http://www.ncbi.nlm.nih.gov/pubmed/2254352">The effect of intravenous fixed-dose heparin during total hip arthroplasty on the incidence of deep-vein thrombosis. A randomized, double-blind trial in patients operated on with epidural anesthesia and controlled hypotension./a>  br/>
                 - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/2466846">Prevention of venous thrombosis after total hip arthroplasty. Antithrombin III and low-dose heparin compared with dextran 40/a>. br/>
                 - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/2777838">Complications of heparin therapy after total joint arthroplasty/a>. br/>
                 - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/1729021">Intraoperative heparin thromboembolic prophylaxis in primary total hip arthroplasty. A prospective, randomized, controlled, clinical trial/a>. br/>
                 - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" ref="linkpos=2&log$=citationsensor" href="http://www.ncbi.nlm.nih.gov/pubmed/2013587">Prevention of deep-vein thrombosis and pulmonary embolism after total hip replacement. Comparison of low-molecular-weight heparin and unfractionated heparin./a> br/>
                 - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/1555341">Intraoperative adjusted-dose heparin thromboembolic prophylaxis in primary total hip arthroplasty/a>. br/>
                 - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/1729021">Intraoperative heparin thromboembolic prophylaxis in primary total hip arthroplasty. A prospective, randomized, controlled, clinical trial/a>. br/>
                 - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/7554633">Efficacy and safety of enoxaparin to prevent deep vein thrombosis after hip arthroplasty/a>. br/>
                 - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/10682733">Recent Advances in Venous Thromboembolic Prophylaxis During and After Total Hip Replacement/a>.   br/>
                 - a href="http://www.ncbi.nlm.nih.gov/pubmed/11263636" ref="linkpos=2&log$=citationsensor">Prolonged enoxaparin therapy to prevent venous thromboembolism after primary hip or knee replacement. Enoxaparin Clinical Trial Group./a> br/>
    - strong>pentasaccharides:/strong> br/>
           - in the report by a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/11228275">Turpie AG, et al/a>., the authors studied the effects of the pentasaccharide Org31540/SR90107A, br/>
                 a highly selective, indirect inhibitor of activated factor X, is the first of a new class of synthetic antithrombotic agents; br/>
                 - double-blind study, patients had doses of one of five daily doses of Org31540/SR90107A, given qd, or to 30 mg of enoxaparin, given q 12 hours; br/>
                 - treatment was continued for 10 days or until bilateral venography was performed after a minimum of 5 days; br/>
                 - of 933 patients treated, 593 were eligible for the efficacy analysis; br/>
                 - with Org31540/SR90107A a dose effect was observed (P=0.002), with rates of venous thromboembolism of 11.8 %, 6.7 %, 1.7 %, 4.4 %,br/>
                        and 0 % for groups assigned to 0.75 mg, 1.5 mg, 3.0 mg, 6.0 mg, and 8.0 mg of drug, as compared with a rate of 9.4 % in enoxaparin group; br/>
                 - reduction in risk of venous thromboembolism was 82 % for 3.0-mg Org31540/SR90107A group (P=0.01) and 29 % for 1.5-mg group (P=0.51); br/>
                 - enrollment in the 6.0-mg and 8.0-mg Org31540/SR90107A groups was discontinued because of bleeding complications; br/>
                 - major bleeding occurred 3.5 percent less frequently in the 0.75-mg group (P=0.01) and 3.0 percent less frequently br/>
                        in the 1.5-mg group (P=0.05) than in the enoxaparin group (in which the rate was similar to that in the 3.0-mg group); br/>
                 - the authors concluded that Org31540/SR90107A, a synthetic pentasaccharide, has the potential to improve significantly the risk-benefit br/>
                        ratio for the prevention of venous thromboembolism, as compared with low-molecular-weight heparin. br/>
                 - ref: a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/11228275">A Synthetic Pentasaccharide for the Prevention of Deep-Vein Thrombosis after Total Hip Replacement/a> br/>
    - strong>a href="/orthopaedics-related-topics/medications/warfarin-coumadin/">warfarin/a>:/strong> br/>
          - references: br/>
                 - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/8314829">Routine use of adjusted low-dose warfarin to prevent venous thromboembolism after total hip replacement/a>. br/>
                 - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/2784442">Warfarin prophylaxis to prevent mortality from pulmonary embolism after total hip replacement/a>. br/>
                 - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/1864061">Intermittent pneumatic compression versus coumadin. Prevention of deep vein thrombosis in lower-extremity total joint arthroplasty/a>. br/>
                 - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/9314399">Prevention of deep venous thrombosis after total hip arthroplasty.  Comparison of warfarin and dalteparin/a>. br/>
                 - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" ref="linkpos=1&log$=citationsensor" href="http://www.ncbi.nlm.nih.gov/pubmed/1516307">Pulmonary embolism in total hip and knee arthroplasty. Risk factors in patients on warfarin prophylaxis and analysis of the prothrombin time as an indicator of warfarin's prophylactic effect./a>br/>
    - strong>compressive devices:/strong> br/>
          - references: br/>
                 - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" ref="ordinalpos=78&ncbi_uid=2013589&link_uid=2013589&linksrc=docsum_title" href="http://www.ncbi.nlm.nih.gov/pubmed/2013589">Intermittent pneumatic compression to prevent proximal deep venous thrombosis during and after total hip replacement. A prospective, randomized study of compression alone, compression and aspirin, and compression and low-dose warfarin./a> br/>
                 - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/1864061">Intermittent pneumatic compression versus coumadin. Prevention of deep vein thrombosis in lower-extremity total joint arthroplasty/a>. br/>
                 - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" ref="linkpos=1&log$=citationsensor" href="http://www.ncbi.nlm.nih.gov/pubmed/20194309">Thrombosis prevention after total hip arthroplasty: a prospective, randomized trial comparing a mobile compression device with low-molecular-weight heparin./a> br/>
    - strong>vena cava filter:/strong> br/>
          - reference: br/>
                 - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/2592395">Use of the Greenfield filter to prevent fatal pulmonary embolism associated with total hip and knee arthroplasty/a>. br/>
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strong>- Treatment:/strong> br/>
    - standard treatment algorithm (confirmation of DVT/PE, followed by IV heparin or SQ low molecular wt heparin, followed by PO warfarin; br/>
    - consider applying a hip spica compression dressing (from toes to waist) to reduce swelling and risk of hematoma; br/>
    - in the report by a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/10466639">Lawton RL and Morrey BF/a> (1999), the authors advise that patients who demonstrate clinical signs of a PE br/>
            should have the diagnosis confirmed before starting empiric IV heparin; br/>
            - they noted at 47% complication rate in their patients (versus 20% in patients that did not receive heparin); br/>
            - they found no benefit to starting IV heparin prior to confirmation of the diagnosis; br/>
            - a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" ref="ordinalpos=3&ncbi_uid=10466639&link_uid=10466639&linksrc=docsum_title" href="http://www.ncbi.nlm.nih.gov/pubmed/10466639">The use of heparin in patients in whom a pulmonary embolism is suspected after total hip arthroplasty./a>br/>
br/>
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br/>
a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/2466846">Prevention of venous thrombosis after total hip arthroplasty. Antithrombin III and low-dose heparin compared with dextran 40/a>. br/>
br/>
a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/457710">The effect of total hip replacement and general surgery on antithrombin III in relation to venous thrombosis/a>. br/>
br/>
a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/8331123">Total hip replacement, lower limb blood flow and venous thrombogenesis/a>. br/>
br/>
a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" ref="ordinalpos=3&ncbi_uid=9393900&link_uid=9393900&linksrc=docsum_title" href="http://www.ncbi.nlm.nih.gov/pubmed/9393900">Mortality and fatal pulmonary embolism after primary total hip replacement. Results from a regional hip register./a>br/>
br/>
a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" ref="ordinalpos=4&ncbi_uid=7822397&link_uid=7822397&linksrc=docsum_title" href="http://www.ncbi.nlm.nih.gov/pubmed/7822397">Death and thromboembolic disease after total hip replacement. A series of 1162 cases with no routine chemical prophylaxis./a>br/>
br/>
a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/8950998">Thromboprophylaxis and death after total hip replacement/a>.  br/>
br/>
a href="http://www.ncbi.nlm.nih.gov/pubmed/10428124" ref="linkpos=2&log$=citationsensor">Comparison of enoxaparin and warfarin for the prevention of venous thromboembolic disease after total hip arthroplasty. Evaluation during hospitalization and three months after discharge./a>  br/>
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a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/18579811">Rivaroxaban versus Enoxaparin for Thromboprophylaxis after Hip Arthroplasty/a>br/>
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a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.ncbi.nlm.nih.gov/pubmed/8772080">Death rate from pulmonary embolism following joint replacement surgery/a>.  br/>
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a onclick="window.open(this.href,'','resizable=no,location=no,menubar=no,scrollbars=yes,status=no,toolbar=no,fullscreen=no,dependent=no,status'); return false" href="http://www.orthosupersite.com/view.aspx?rid=81542">Danish hip arthroplasty data show that thromboembolic events occurred on average 22 days following surgery/a>/div>br/>hr/>br/>br/>br/>Last updated by on Friday, May 18, 2012 12:13 pmbr/>

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