Discharge screens for DVT not justified for hip, knee
Discharge screens for DVT not justified for hip, knee
A new Canadian study of 1,000 patients undergoing total hip or knee arthroplasty suggests that hospital discharge ultrasonographic screening for deep venous thrombosis (DVT) is unnecessary.
Of those patients, only 1% developed symptomatic thromboembolic complications within 90 days of surgery, the researchers said. (For the published study, see the Annals of Internal Medicine 1997; 127:439-445.)
Dr. David R. Anderson of the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia, Canada, said that the rates of subsequent thromboembolic complications over a nine-day follow up period were similar in patients who had normal bilateral compression ultrasonography at discharge and patients who underwent sham screening.
In the same paper, the researchers reported that the use of warfarin prophylaxis in patients undergoing hip and knee replacement surgeries achieved low rates of symptomatic deep venous thrombosis and pulmonary embolism post-discharge in the study group. Nine days of post-operative warfarin therapy was sufficient prophylaxis, the researchers said, while major bleeding episodes were low and clinically acceptable.
Their conclusion is that predischarge screen-ing for DVT is not necessary, at least in patients who have received postoperative warfarin prophylaxis.
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