Symposium – Recent Advances in Venous Thromboembolic Prophylaxis During and After Total Hip Replacement

Total hip replacement is an operation that is particularly prone to thromboembolic complications with potentially life-threatening consequences. Johnson et al., in a series of 7959 total hip replacements performed between 1962 and 1973, reported that the overall prevalence of pulmonary embolism was 7.89 percent and that of fatal pulmonary embolism was 1.04 percent51,52. Similarly, in 1974, Coventry et al. reported an overall prevalence of pulmonary embolism of 2.2 percent in a series of 2012 consecutive total hip replacements16. In a subset of sixty-two patients who had received no prophylactic anticoagulation, the prevalence of fatal pulmonary embolism was 3.4 percent. However, the average duration of the operation was 2.4 hours, the average blood loss was 1650 milliliters, and the average volume of blood transfused was 1144 milliliters. Prophylactic anticoagulation with warfarin was started five days after the operation. Patients were managed with bed rest for an average of one week before walking was allowed, and they were discharged at an average of three weeks after the operation17.