Thromboembolism After Total Knee Arthroplasty: Intermittent Pneumatic Compression and Aspirin Prophylaxis

Christopher M. Larson, MD, Douglas P. MacMillan, MD, Paul F. Lachiewicz, MD

Disclosures

J South Orthop Assoc. 2001;10(3) 

In This Article

Abstract and Introduction

This is a study of two consecutive antithromboembolism regimens after total knee arthroplasty. In group 1, 131 patients were given aspirin prophylaxis alone (650 mg by mouth twice a day). In group 2, 123 patients were treated with aspirin, knee-high compression stockings, and intermittent knee-high pneumatic compression devices, which were started intraoperatively. The prevalence of deep vein thrombosis in group 1 was 15.9% (21 of 131 patients). One patient had a possible symptomatic nonfatal pulmonary embolism, and one patient had a symptomatic calf thrombus. Asymptomatic thrombi were detected in calf veins in 9 patients, popliteal vein in 6 patients, and femoral vein in 5 patients. In Group 2, the prevalence was 7.4% (9 of 123 patients). Asymptomatic thrombi were located in calf veins in 6 patients, popliteal vein in 1 patient, and femoral vein in 2 patients. There was a significant difference in the prevalence of deep vein thrombosis between the two groups. A history of previous thromboembolism was a significant risk factor for a new thrombus. The prevalence after bilateral one-stage knee arthroplasty was 24.3% for group 1 and 12.5% for group 2. Aspirin and knee-high intermittent pneumatic compression together are more effective than aspirin alone for prevention of deep vein thrombosis after primary and revision knee arthroplasty.

Thromboembolism continues to be a frequent postoperative complication of total knee arthroplasty. Without prophylaxis, thromboembolism has been reported to occur in 40% to 84% of patients having total knee arthroplasty.[1,2,3,4,5,6] Symptomatic pulmonary embolism after total knee arthroplasty has been reported to occur in 1.8% to 7.0% of patients without prophylaxis, with 0.2% to 2.0% of those being fatal.[2,7,8] Controversy exists regarding optimal prophylaxis against thromboembolism after total knee arthroplasty. The various methods used have included aspirin, low doses of low molecular weight heparin with or without antithrombin III, warfarin, and intermittent pneumatic compression devices. In a recent review of trials, the reported prevalence of thromboembolism after knee arthroplasty with various methods of prophylaxis ranged from 11% to 79%.[4]

Intermittent pneumatic compression devices have been found to decrease venous stasis, accelerate emptying of the venous system, and increase systemic and local fibrinolysis.[9,10] Two previous studies of 119 and 122 patients, respectively, reported a reduction in the incidence of thrombi after knee arthroplasty from 55% to 33% and from 59% to 27%, respectively, with the use of plantar compression devices and aspirin compared with aspirin alone.[10,11] Another report of 61 patients having elective knee surgery noted a reduction in the rate of thromboembolism from 52% to 8% in a subset of patients taking aspirin with the use of intermittent calf compression.[12] The purpose of the current study was to compare the efficacy of aspirin, knee-high compression stockings, and knee-high intermittent pneumatic compression devices versus aspirin alone for prophylaxis against thromboembolism after total knee arthroplasty.

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