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Prevention of Deep-Vein Thrombosis After Total Knee Arthroplasty in Asian Patients

Comparison of Low-Molecular-Weight Heparin and Indomethacin

¹ Departments of Orthopedic Surgery (C.-J.W., J.-W.W., L.-H.W., and C.-C. Hsu) and Diagnostic Radiology (C.-C. Huang and P.-C.Y.), Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung 833, Taiwan. E-mail address for C.-J. Wang: w281211{at}adm.cgmh.org.tw.

Investigation performed at the Departments of Orthopedic Surgery and Diagnostic Radiology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Methods: One hundred and fifty patients undergoing total knee arthroplasty were randomly divided into three groups. One group consisted of fifty-one patients who received no prophylaxis with an anticoagulant (the control group), one consisted of fifty patients who received the low-molecular-weight heparin Fraxiparine (the Fraxiparine group), and the third consisted of forty-nine patients who received indomethacin (the indomethacin group). Bilateral ascending venography was performed preoperatively and at five, six, or seven days postoperatively. A third venogram was made at three months for patients who had had a deep-vein thrombosis.

Results: The prevalence of deep-vein thrombosis was 71% in the control group, 50% in the Fraxiparine group (p = 0.042), and 45% in the indomethacin group (p = 0.011). Only 28% of the deep-vein thromboses were symptomatic, and there were no pulmonary emboli.

Conclusions: Compared with no prophylaxis, Fraxiparine and indomethacin significantly lowered the prevalence of deep-vein thrombosis after total knee arthroplasty. Prophylaxis against deep-vein thrombosis in the Asian population appears to be warranted.

Level of Evidence: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.

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