Failure of the American College of Chest Physicians-1A Protocol for Lovenox in Clinical Outcomes for Thromboembolic Prophylaxis
Burnett, R. Stephen J.; Clohisy, John C.; Wright, Rick W.; McDonald, Douglas J.; Shively, Robert A.; Givens, Stephanie A.; Barrack, Robert L.Hip Knee
A total of 290 consecutive patients who underwent total hip and total knee arthroplasty were prospectively entered into a clinical anticoagulation trial using a 10-day course of Lovenox with the American College of Chest Physicians-1A guidelines. Major complications occurred in 9% of patients; symptomatic deep vein thrombosis occurred in 9 (3.8%) patients, and nonfatal pulmonary embolism in 3 (1.3%) patients. Complications included 4.7% readmissions, 3.4% return to the operating room for wound incision and drainage, 5.1% prolonged hospitalization (wound drainage), and 3.4% injection site complications. Wound drainage of more than 7 days was predictive of readmission and wound reoperation. A body mass index of more than 35 was predictive of prolonged wound drainage. Return to the operating room for wound complications occurred 3× more frequently with the use of Lovenox than in our previous study using warfarin. Surgical site complications requiring readmission or reoperation should be considered “major” complications.
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