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A Journal on Phlebology
Acta Phlebologica 2001 December;2(2-4):67-70
The Delta Hospital Study: the combination of elastic stockings and LMWH in orthopaedic elective surgery
Marchetti F. 1, Artioli M. 2, Pancaldi F. 1, Faccini S. 2, Zamboni P. 1
1 Università degli Studi, Ferrara, Dipartimento di Scienze Chirurgiche, Anestesiologiche e Radiologiche;
2 Ospedale del Delta, Ferrara, Divisione Ortopedica
BACKGROUND: Low molecular weight heparin (LMWH) and elastic stockings are both useful methods for preventing venous thromboembolism (VTE) after surgery. Since elective hip and knee surgery are both considered high risk procedures for the development of postoperative VTE, a prospective study has been planned in order to verify if the combination of LMWH and elastic stockings could be adjuvant in reducing the rate of postoperative VTE. In addition, the postoperative control of edema by the means of elastic stockings has been evaluated.
METHODS: Sixty consecutive patients underwent elective hip and knee procedures according to the following protocol: preoperative duplex to exclude previous venous thrombosis. Combination of LMWH at prophylactic dosage and elastic stockings exerting 20-30 mmHg at the ankle of both the legs starting from the day before the operation. D-Dimer was tested in the blood on postoperative day 3/15/30 and duplex was repeated after 3 weeks. Moreover measurements of ankle, calf and thigh circumference were performed before the procedure and at the time of hospital discharge.
RESULTS: The rate of venous thrombosis detected was 7.7%, always in the calf veins, without any case of progression forward the more proximal segments and without any clinical sign of pulmonary embolism. Pre- and postoperative lower extremity circumferences were not significantly different.
CONCLUSIONS: The rate of VTE registered in the present study seems to confirm that the combination of LMWH and elastic stockings can be adjuvant in VTE prophylaxis in high risk patients submitted to elective orthopedic surgery. In addition, elastic stockings were able to minimize postoperative oedema.