Kaempffe FA, Lifeso RM, Meinking C.
Intermittent pneumatic compression versus coumadin. Prevention of deep vein
thrombosis in lower-extremity total joint arthroplasty.
Clin Orthop 1991 Aug;(269):89-97

Department of Orthopaedic Surgery, State University of New York, Buffalo School
of Medicine 14215.

One hundred forty-nine consecutive patients requiring lower extremity total joint
arthroplasty were randomized to either coumadin (52 patients) or intermittent
pneumatic compression (48 patients) as prophylaxis against deep vein thrombosis
(DVT). Forty-nine patients were excluded. When fully ambulatory, the presence or
absence of DVT was diagnosed by ascending venography (90% of patients), nuclear
venography, venous dopplers, or impedence plethysmography. The two groups were
similar in average age (64 years), indication for arthroplasty (pain because of
arthritis in 90%), gender (98% male), and average number of risk factors (2.4).
Twenty-five percent of patients on coumadin and 25% of patients on intermittent
pneumatic compression (IPC) developed DVT. IPC was more effective than coumadin
following primary total hip arthroplasties (THAs) (16% versus 24% incidence DVT);
coumadin was more effective than IPC following primary total knee arthroplasties
(TKAs) (19% versus 32% incidence of DVT). DVT developed in 36% of patients
following revision arthroplasty. Seventy-five percent of all thrombi were
proximal. Both IPC and coumadin were found to be safe; there was no increased
perioperative bleeding in the coumadin group. Of three postoperative deaths, one
was possibly due to pulmonary embolism (PE).