Initiating versus delaying treatment-dose anticoagulation in suspected venous thromboembolism (VTE) in post-operative hip and knee arthroplasty patients: Outcomes and risks.

BACKGROUND: Hip and knee arthroplasty is a risk factor for venous thromboembolism (VTE). Initiation of treatment-dose anticoagulation in the post-operative period in suspected cases prior to confirmed diagnosis involves balancing increased bleeding risk to VTE-associated morbidity.

METHODS: A single-centre retrospective cohort study was undertaken comparing outcomes of empirical treatment of suspected VTE in post-operative elective lower-limb arthroplasty patients as opposed to delaying treatment until diagnosis is confirmed. All patients undergoing ultrasonography (US) or CT-pulmonary-angiogram (CTPA) for suspected VTE following elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) between 05/05/17 and 19/07/21 were identified. Primary outcomes were surgical site infection (SSI), readmission, and other wound problems within 30-days of surgery.

RESULTS: 107 patients were included for analysis. 93 patients had suspected deep venous thrombosis (DVT), 21 had suspected pulmonary embolism (PE), and 7 were investigated for both DVT and PE. Empirical treatment-dose anticoagulation was initiated in 4 patients with suspected pulmonary embolism (PE) prior to CTPA, and 34 patients with suspected deep venous thrombosis (DVT) prior to US. No significant differences were noted in 30-day readmission rate ([DVT: 12 % vs 23 %, p = 0.41], [PE: 50 % vs 33 %, p = 1.00]), SSI rate ([DVT: 6 % vs 3 %, p = 1.00], [PE: 0 % vs 11 %, p = 1.00]) or other wound complication rate ([DVT: 3 % vs 3 %, p = 1.00), [PE 0 % vs 11 %, p = 1.00]) between empirically and non-empirically treated groups respectively.

CONCLUSION: Empirical initiation of therapeutic anticoagulation in post-operative lower limb arthroplasty patients with suspected VTE appears to be safe practice prior to a definitive diagnosis.