Goldstein WM, Jimenez ML, Bailie DS, Wall R, Branson J.
Safety of a clinical surveillance protocol with 3- and 6-week warfarin prophylaxis
after total joint arthroplasty.
Orthopedics 2001 Jul;24(7):651-4

Illinois Bone and Joint Institute, Desplaines 60016, USA.

The charts of 1869 patients were reviewed for the occurrence of deep venous
thrombosis (DVT) and pulmonary embolism after total hip or knee arthroplasty.
Prophylaxis consisted of 3 (group 1; n=1235) or 6 (group 2; n=634) weeks low-dose
warfarin, pneumatic compression boots worn by patients in the hospital,
mobilization on the first postoperative day, and a clinical surveillance
protocol. Venous ultrasound or ventilation/perfusion lung scintigraphy (V/Q) was
performed only if patients became symptomatic. patients. Twenty-three (1.8%)
patients were positive for DVT. Ventilation/perfusion lung scintigraphy was
performed on 25 patients, and 5 (0.4%) patients were positive for pulmonary
embolism. In group 2, 117 patients were evaluated for DVT, and 19 (3%) patients
had positive results determined by ultrasound. Twenty-five patients were
evaluated with V/Q and only 1 (0.16%) patient was positive for pulmonary
embolism. No patient developed a fatal pulmonary embolism or postphlebitic
syndrome. This prophylaxis protocol is an efficient and cost-effective method for
the prevention of significant events after surgery.