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The Journal of Bone and Joint Surgery, Vol 71, Issue 3 321-326, Copyright © 1989 by Journal of Bone and Joint Surgery, Inc
Warfarin prophylaxis to prevent mortality from pulmonary embolism after total hip replacement
HC Amstutz, DA Friscia, F Dorey and BT Carney
Division of Orthopaedic Surgery, Center for the Health Sciences, University of California, Los Angeles School of Medicine 90024-1749.
Between 1970 and 1987, 3000 total hip replacements were performed at the
University of California at Los Angeles, and all patients were given
warfarin prophylactically, in conjunction with early postoperative
elevation of the lower limb in balanced suspension and the application of
elastic hose. Since 1973, the first dose of warfarin has been given on the
night of the operation, and the prothrombin time has been maintained
between sixteen and eighteen seconds. A pulmonary embolism occurred after
fourteen (0.5 per cent) of the 3000 operations. It was never fatal.
Bleeding occurred after forty-four operations (1.5 per cent). The
effectiveness of the protocol of the University of California at Los
Angeles was demonstrated in a large number of patients over a
seventeen-year period. Since 1974, the protocol has included closer
monitoring of the prothrombin time. After 2595 hip replacements that were
done between 1974 and 1987, the rate of pulmonary embolism was 0.2 per cent
and the rate of bleeding complications was 1.0 per cent. However, recently
a higher incidence of bleeding complications (2.3 per cent) has been noted
after non-cemented total hip (stem-type) replacement.
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