Prevention of Venous Thromboembolism after Hospital Discharge Continued Pharmacological Prophylaxis versus No Prophylaxis in Patients Undergoing Total Hip Replacement

Abstract

After total hip replacement, continued pharmacological prophylaxis following hospital discharge is controversial. The primary objective of our study was to determine the safety and efficacy of continued prophylaxis with nadroparin three weeks after hospital discharge. The secondary objective was to evaluate the association between a confirmed venous thromboembolism and risk factors for deep venous thrombosis. This study was an open-label, randomized, multicentre, prospective trial. Patients were evaluated for deep venous thrombosis with duplex ultrasonography at discharge and 3 weeks later. Walking ability (mobility score) was assessed at the same times. Patients without deep venous thrombosis at discharge were randomly assigned to continued nadroparin (n=155) versus no pharmacologic prophylaxis (n=141) for three weeks. The rate of deep venous thrombosis three weeks post discharge was significantly lower in the nadroparin group: two patients (1.3%) versus nine (6.4%) without prophylaxis (p = 0.021; relative risk reduction = 79%). No significant difference in terms of safety was observed between groups and no major bleeding occurred. Three weeks after discharge, patients who developed deep venous thrombosis were significantly less mobile (p = 0.018). In conclusion, after total hip replacement, continued prophylaxis with nadroparin for 3 weeks after hospital discharge is beneficial.