A Prospective Study of Venous Thromboembolic Prophylaxis Using Foot Pumps Following Total Knee Replacement in a Chinese Population

PurposeThe purpose of this study was to evaluate foot pumps as mechanical prophylaxis for deep vein thrombosis (DVT) following total knee replacement (TKR) in a Chinese population.MethodsAll consecutive patients following TKR during 2002–2006 received routine duplex ultrasound surveillance for DVT 9 days postoperatively. The demographic data and risk factors were recorded. No medication was given for DVT prophylaxis in all patients.ResultsWe evaluated 91 consecutive TKRs in 85 patients. Although 44 knee replacements (Group 1) done before December 2004 were not given foot pumps, 47 knee replacements (Group 2) done afterwards were given foot pumps. All patients were followed up for more than 6 months. DVT was detected in three cases (6.8%) in Group 1 compared with four knees (8.5%) in Group 2. Proximal thrombosis was observed in two knees (4.5%) in Group 1 compared with two knees (4.3%) in Group 2. No patient had pulmonary embolism. Six out of 59 (10.2%) patients who underwent the operations under general anaesthesia suffered from DVT, whereas one in 28 (3.6%) patients operated under spinal anaesthesia had DVT. All had no statistical significance.ConclusionThe rate of proximal DVT after TKR was low (4.5%) without pharmacological prophylaxis. We advise against the use of pharmacological prophylaxis in Chinese population for TKRs because of the low risk of proximal DVT and its possible bleeding complications. Foot pump did not lower the rate of DVTfurther, and its use for DVT prophylaxis in TKR is not necessary.

中文摘要目的評估腳泵對華籍病人於全膝關節置換術後作為機械性預防深靜脈血栓的作用。方法由2002年8月到2006年12月，所有連續華籍病人在全膝關節置換術後9天均進行多普勒超聲以檢測深靜脈血栓，並紀錄有關人口統計數據和風險因素。所有病人均沒有給予藥物預防深靜脈血栓結果我們評估連續85位病人的91個全膝關節置換術個案，將病例分成2組, 第1組的44例在2004年12月前進行手術，並沒有給予腳泵；其後進行手術的第2組47例均給予腳泵。並對所有病人進行隨訪多於6個月，發現第1組有3例(6.8%)而第2組有4例(8.5%)深靜脈血栓，第1組有2例(4.5%)而第2組也有2例(4.3%)有近端血栓，沒有病人患上肺栓塞。59人進行全身麻醉中有6例(10.2%)有深靜脈血栓比對28人進行脊髓麻醉中的1例(3.6%)。在統計上的分別是不顯著。結論在沒有藥物預防下進行全膝關節置換術後的近端深靜脈血栓率很低(4.5%)。基於可能產生流血的併發症和低風險的近端深靜脈血栓率，作者不建議在華籍病人中使用藥物作預防。使用腳泵並沒有再減低深靜脈血栓率，它在預防全膝關節置換術後的深靜脈血栓是不必要的。