Failure of the American College of Chest Physicians-1A Protocol for Lovenox in Clinical Outcomes for Thromboembolic Prophylaxis

R. Stephen J. Burnett, John C. Clohisy, Rick W. Wright, Douglas J. McDonald, Robert A. Shively, Stephanie A. Givens, Robert L. Barrack

Research output: Contribution to journalArticle

91 Scopus citations

Abstract

A total of 290 consecutive patients who underwent total hip and total knee arthroplasty were prospectively entered into a clinical anticoagulation trial using a 10-day course of Lovenox with the American College of Chest Physicians-1A guidelines. Major complications occurred in 9% of patients; symptomatic deep vein thrombosis occurred in 9 (3.8%) patients, and nonfatal pulmonary embolism in 3 (1.3%) patients. Complications included 4.7% readmissions, 3.4% return to the operating room for wound incision and drainage, 5.1% prolonged hospitalization (wound drainage), and 3.4% injection site complications. Wound drainage of more than 7 days was predictive of readmission and wound reoperation. A body mass index of more than 35 was predictive of prolonged wound drainage. Return to the operating room for wound complications occurred 3× more frequently with the use of Lovenox than in our previous study using warfarin. Surgical site complications requiring readmission or reoperation should be considered "major" complications.

Original languageEnglish
Pages (from-to)317-324
Number of pages8
JournalJournal of Arthroplasty
Volume22
Issue number3
DOIs
StatePublished - Apr 1 2007

Keywords

  • American College of Chest Physicians Guidelines
  • Lovenox
  • anticoagulation
  • complications
  • deep vein thrombosis
  • low molecular weight heparin
  • pulmonary embolism
  • surgical site infection
  • total hip arthroplasty
  • total knee arthroplasty

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