To evaluate the efficacy and safety of enteric coated Acetlsalicylic acid (ECASA) in prevention of deep vein thrombosis(DVT), nonfatal and fatal pulmonary embolism (PE) in primary total hip arthroplasty (THA) performed through the anterior approach.
A retrospective analysis of prospectively collected data of a consecutive series of 1016 patients (age range 22–90 years) who underwent anterior THA was performed. Exclusion criteria were previous hip surgery and preoperative anticoagulation therapy. The remaining 852 patients (430 males and 422 females) were analyzed.There were 733 unilateral procedures and 119 bilateral procedures. All surgeries were performed by a single surgeon. All patients had knee-high graduated elastic stockings (TEDS) and intermittent compression devices during surgery and for the duration of the hospital stay. All patients were mobilized weight bearing as tolerated within the first 12 hours after surgery. ECASA therapy was initiated immediately postoperatively. Patients received 325 mg of ECASA twice daily and a proton pump inhibitor daily for one month. All patients were examined with duplex ultrasonography prior to discharge. TED stockings were worn for one month postoperatively.
There were three cases of DVT (0.35%), all of which occurred in men in unilateral cases. One of these developed a non-fatal PE (0.11%).One was non-compliant with the dose of ECASA. One had a DVT in the contralateral leg. All three were treated successfully with anti-thrombotic therapy. There were no fatal PE cases. There were no cases of gastrointestinal bleeding.
ECASA is an inexpensive, safe and effective method for prophylaxis against thromboembolic disease after anterior approach THA. The use of ECASA as a pharmacologic agent combined with TED stockings and intermittent compression devices during the immediate perioperative period and early unrestricted mobilizaion produced superior results compared to current recommended guidelines by the ACCP.
Patients without increased risk factors for DVT are good candidates for prophylaxis therapy with ECASA combined with TED stockings and compression devices after primary anterior THA.
Andrew Fishmann, No Financial Disclosure Information; No Product/Research Disclosure Information