Paiement GD, Schutzer SF, Wessinger SJ, Harris WH.
Influence of prophylaxis on proximal venous thrombus formation after total hip
arthroplasty.
J Arthroplasty 1992 Dec;7(4):471-5

Orthopaedic Biomechanics Laboratory, Massachusetts General Hospital, Boston 02114.

Deep vein thrombosis (DVT) is the most frequent complication after total hip
arthroplasty, and proximal DVT is more likely to produce clinical pulmonary
emboli than distal DVT. The authors have assessed the incidence and anatomic
location of phlebographically proven fresh DVT following total hip arthroplasty
in 855 patients over 39 years of age. Eight different regimens (2 warfarin, 3
aspirin, 1 dextran, 1 external pneumatic compression, and 1 dextran combined with
external pneumatic compression) were evaluated and compared with an historical
placebo control group from the same institution. No significant difference (P <
.05) existed in proximal DVT incidence between the placebo group and any of the
three aspirin groups, the dextran group, the external pneumatic compression
group, or the dextran combined with external pneumatic compression group. In
contrast, warfarin, given both in traditional and low-dose regimens, provided a
significant reduction in proximal DVT compared with the placebo group (P < .001;
statistical power, 0.84 and 0.99, respectively). The low-dose regimen had 10
times fewer bleeding complications than the traditional regimen. All prophylaxis
regimens should be evaluated for both proximal and distal DVT formation, as well
as for overall incidence. Low-dose warfarin offers the best protection against
proximal thrombi of the agents studied, and it is also safer than traditional
dosages of warfarin.