Fixed low-dose versus adjusted higher-dose warfarin following orthopedic surgery. A randomized prospective trial.

Abstract

Orthopedic patients are at a high risk for developing venous thromboembolism, yet only a fraction of eligible patients receive anticoagulation prophylaxis after hospital discharge. This pilot study compared the efficacy of a fixed 2 mg/d dose of warfarin versus an adjusted higher dose of warfarin for 1 month after discharge to prevent the development of proximal leg deep venous thrombosis among recently discharged orthopedic patients. After standard inhospital treatment with adjusted higher-dose warfarin and a predischarge leg ultrasound to exclude deep venous thrombosis, 96 orthopedic patients were randomized just prior to discharge to either fixed low-dose (n = 49) or adjusted higher-dose warfarin (n = 47). At the 6-week follow-up evaluation, ultrasonographically confirmed, asymptomatic, proximal leg deep venous thrombosis occurred in two patients (4%). Both patients were randomized to the fixed low-dose group, although one remained on adjusted higher-dose warfarin throughout the trial. No patient in either group developed major bleeding complications. Further studies should be undertaken to further test fixed low-dose warfarin for venous thromboembolic prevention in high-risk orthopedic patients.

• Authors: M G Wilson, L F Pei, K M Malone, J F Polak, M A Creager, S Z Goldhaber
• Journal: The Journal of arthroplasty (J Arthroplasty) Vol. 9 Issue 2 Pg. 127-30 (Apr 1994) ISSN: 0883-5403 [Print] United States
• PMID: 8014642 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Warfarin

Topics

• Female
• Follow-Up Studies
• Hip Fractures (surgery)
• Hip Prosthesis
• Humans
• Knee Prosthesis
• Male
• Middle Aged
• Postoperative Complications (epidemiology, prevention & control)
• Prospective Studies
• Thrombophlebitis (epidemiology, prevention & control)
• Time Factors
• Warfarin (administration & dosage, therapeutic use)