Yen D.
Current concepts in the prevention, detection, and treatment of deep vein
thrombosis in total hip and knee replacement.
Curr Opin Rheumatol 1992 Apr;4(2):210-5

University of Toronto, Ontario, Canada.

In hip replacement, prophylaxis of thromboembolism with warfarin to 1.5 times
control with respect to prothrombin time remains efficacious. Further reduction
of the dosage has not met with success. Confirmatory studies on the usefulness of
adjusted-dose heparin and low molecular weight heparin continue. Promising new
methods include intravenous intraoperative heparin, intermittent pneumatic
compression alone, and the combination of antithrombin III and fixed-dose
heparin. It is now recognized that knee replacement carries a similar risk of
thromboembolism as hip replacement. Recent work has demonstrated the
effectiveness of sequential pneumatic compression, adjusted-dose heparin, and the
combination of antithrombin III and fixed-dose heparin. Venography remains the
gold standard for detection of deep vein thrombosis. Recent interest has centered
around the use of the less invasive technique of ultrasound. Anticoagulation with
intravenous heparin followed by oral warfarin remains standard treatment for
proximal thrombi and also distal deep vein thrombosis, in which serial screening
methods for proximal extension are unavailable.