Zeitschrift für Hämatologie und thromboembolische Erkrankungen
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Combined Short Course Low Molecular Weight Heparin and Calf Compression Therapy in Prevention of Deep Vein Thrombosis after Total Knee Replacement: A Randomized Prospective Study

Raj Ramakrishna, Sarika Gupta, Kiran Sarathy, Marijka Batterham and George Kirsh

Background and aims: Anti-coagulation is an important component of post-operative Venous-Thombo-Embolic (VTE) prophylaxis but can be associated with significant complications including hemorrhage. Current guidelines favour anti-coagulation for ≥ 14 days with little evidence evaluating the efficacy of anticoagulation <14 days. Our study hypothesizes that short course Low-Molecular-Weight-Heparin (LMWH for 5-7 days) in combination with Calf Compression Device (CCD) is equally effective as standard therapy LMWH (14 days) in preventing VTE and related events amongst patients undergoing Total-Knee-Replacement (TKR).

Methods: Eighty-three patients undergoing TKR were randomly allocated to either: Group 1 short course LMWH (5-7 days) with CCD or Group 2 standard course LMWH only (14 days). Patients were followed up daily for five days post-operative and then at regular intervals for twelve weeks assessing for: deep-vein-thrombosis and pulmonary embolus, bleeding, exaggerated pain, wound infection, leg swelling and need for extended hospitalization beyond 5 days. Incidence comparisons between groups were made using Pearson’s chi-square or Fischer’s Exact tests and an accepted group treatment difference of 15% was selected based on previous studies to calculate equivalence powers.

Results: The incidence of DVT was equal between groups (n=3), 2% (95% CI -13.4, 14.1%). There was a single case of asymptomatic PE in the short course group though the group difference was not significant (p=0.486). Patients in the short course therapy group also demonstrated significantly lower rates of post operative leg swelling (p=0.004). Group comparisons for all other study endpoints did not reach significance.

Conclusions: In this study combined short course therapy was equally effective as standard therapy in preventing DVT and non-fatal PE, and superior to standard therapy in limiting post-operative leg swelling amongst patients undergoing TKR. Trial registered at Australian New Zealand Trial Registry: ACTRN12613000240741.