Deep vein thrombosis: prophylaxis:total hip replacement: LMWH continued beyond discharge reduced DVT.

Clinical bottom line (level 1b)

  1. Patients who underwent total hip replacement and were given enoxaparin, were less likely to have deep vein thrombosis than those given placebo (NNT = 8 at 3 months) .
Planes et al: Lancet 1996; 348: 224-228
Expires May 2003

The study

Double-blinded concealed randomised trial with intention-to-treat
Setting: acute hospital, France

173 patients (aged mean 69 years, 59% male) undergone primary or revision of total hip replacement

Excluded if
  • <45 years old
  • weighing <45 hg or >95 kg
  • not able to walk without assistance
  • not diagnosed by bilateral venogram
  • documented DVT/PE in last six months
  • active cancer
  • underlying bleeding disorder or abnormal blood results
  • PT<60%, aPTT >8 seconds control
  • active GU/DU
  • history of heparin or contrast allergy
  • hepatic or renal dysfunction (creatinine >150)
  • uncontrolled hypertension
  • stroke in last six months


    • Control Group: (n = 88, 88 analysed): placebo
    Experimental Group: (n = 85, 85 analysed): enoxaparin 40 mg subcutaneously once daily for 35 days
    All patients wore compression stockings during the day and had low molecular weight heparin until discharge. Patients were discharged at day 13-15 post-op, and then randomised.
    100% followed for 3 months

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    deep vein thrombosis 3 months 19
    (19.3%)    		 6
    (7.06%)    		 63%
    (12% to 85%)    		 12.3%
    (2.38% to 22.1%)    		 8
    (5 to 42)

  • No patient had a pulmonary embolism, major haemorrhage or died during the study.
  • No comment was made about side effects (eg. osteopenia or thrombocytopenia).

    • Comments

    1. The study is too small to show any effect on pulmonary embolism, haemorrhage or mortality.
    2. About 20% of patients have a DVT within 21 days of leaving hospital after total hip replacement.

    Citation

    1. Planes A, Vochelle N, Darmon JY, et al: Risk of deep-venous thrombosis after hospital discharge in patients having undergone total hip replacement: double-blind randomised comparison of enoxaparin versus placebo. Lancet 1996; 348: 224-228
    Contributor: Chris Ball and Clare Wotton, May 2000
    Reviewer:

    Clinical Question.
    Patient total hip replacement
    Intervention or Exposure enoxaparin
    Comparison placebo
    Outcome DVT