75^th Annual Meeting Podium Presentations

Adult Reconstruction Hip 6: Osteonecrosis and General Topics in THA

Thrombosis Prevention in Total Hip Arthroplasty: CECT vs LMWH

Podium No: 580

Friday, March 07, 2008
05:12 PM - 05:18 PM

Location: Moscone Convention Center
Room 250-262

Clifford W Colwell Jr, MD La Jolla CA
Merrill A Ritter, MD Indianapolis IN
Mark I Froimson, MD Cleveland OH
Knute C Buehler, MD Bend OR
Douglas E Padgett, MD New York NY
Robert T Trousdale, MD Rochester MN
Kenny Mai, MD Hanford CA
Michael A Mont, MD Baltimore MD

Moderator(s):
Gregory Golladay, MD Grand Rapids MI
Thomas Parker Vail, MD San Francisco CA

A portable mechanical device, can potentially replace pharmacological agents in prophylaxis of VTED after total hip arthroplasty (THA).

The purpose of our prospective randomized study is to evaluate effectiveness of a new mobile, miniature compression device (CECT) compared with low-molecular-weight heparin (LMWH) for venous thromboembolic disease (VTED) prophylaxis after THA.

THA patients who consented are randomized to receive LMWH (enoxaparin 30 mg subcutaneously twice daily) or CECT for 10 days. CECT patients begin treatment intraoperatively and may receive 81 mg aspirin daily after surgery. LMWH patients receive first enoxaparin injection 12-24 hrs after surgery. After 10 days, all patients undergo bilateral lower extremity duplex ultrasound to screen for DVT. Bleeding events and CECT compliance are also documented. Clinical evaluation of DVT and PE are done at 12 weeks. Two-sample t-test and chi-square test are used for testing differences between LMWH and CECT groups.

Patients were evenly randomized to each group. Demographics were similar between groups. Mean age was 60 years; mean BMI was 28.1. CECT compliance rate was 87% over 10 days with 52.8% receiving aspirin postoperatively. Mean treatment was 9.4 (1-11) of 10 days for LMWH group. Distal and proximal DVT occurred in 5% and 1.3% of CECT patients, respectively, compared with 3% distal and 0% proximal DVT in LMWH patients. PE occurred in 0% of CECT; 1.4% of LMWH with no fatal PE. Bleeding rate was 1.3% for CECT and 4.3% for LMWH. At 12-week follow-up, no additional DVT or PE was found by clinical exam.

Results demonstrate CECT to be noninferior to enoxaparin in reducing VTED with decreased bleeding after THA.

A ^· to the left of the title indicates the FDA has not cleared the drug or device for the described purpose.

An alphabetical listing of disclosures is available.

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