EFFICACY AND SAFETY OF LOW-DOSE WARFARIN PROPHYLAXIS COMMENCED PREOPERATIVELY IN CEMENTED TOTAL KNEE REPLACEMENTS

One hundred and fifty six consecutive cemented total knee arthroplasti es (TKA) in 147 patients (39 males, 108 females, mean age: 67) receive d preoperatively low-dose-warfarin for thromboembolic prophylaxis. War farin 10 mg was given the night before surgery and warfarin 5 mg the n ight of surgery. Thereafter, the dosage was adjusted to maintain a pro thrombin time between 1.2-1.5 times control (INR = 2.0-3.0). The scree ning for any deep vein thrombosis (DVT) in the operated limb was by as cending venography. The reported incidence of DVT after TKA without pr ophylaxis is superior to 50%, more than 10% of those are proximal DVT. In this study, the overall incidence of DVT is down to 22.4%. Only fi ve patients (3.4%) had a proximal DVT. There were no deaths and no cli nical pulmonary embolisms. Patients with venous insufficiency had a si gnificantly higher incidence of DVT (36.7%, p = 0.05). The average blo od loss was 406 ml. Three major local bleedings occured (2.0%). At one year follow-up, there were no infections. Low dose warfarin is effica cious in reducing DVT formation with TKA. It is safe and does not crea te excessive bleeding in cemented TKA.