Anticoagulant treatment of thromboembolism with intravenous heparin therapy in the early postoperative period following total joint arthroplasty

Background: Treatment of thromboembolism with intravenous heparin therapy i n the early postoperative period after total joint arthroplasty has been as sociated with a high rate of complications. The purpose of the present stud y was to compare the rate of bleeding complications in a group of patients who required intravenous heparin therapy for the treatment of thromboemboli sm after total hip or knee arthroplasty with the rte in a control group of patients who received only prophylactic anticoagulation. Methods: The postoperative courses of forty-four consecutive patients who w ere managed with intravenous administration of heparin and oral administrat ion of warfarin:for the treatment of a thromboembolic event following unila teral total hip or knee arthroplasty were compared with those of a control group of 376 consecutive patients who had these same procedures but did not have a thromboembolic complication. The patients in the control group were managed with prophylactic anticoagulation with use of enoxaparin. Sixty-ei ght percent (thirty) of the forty-four patients in the heparin group receiv ed the initial dose of heparin on or before the fourth postoperative day, a nd 82 percent (thirty-six) received an initial bolus of 5000 units of hepar in at the initiation of therapy Results: The rate of bleeding complications was 9 percent (four of forty-fo ur) in the heparin group, compared with 6 percent (twenty-three of 376) in the control group (p = 0.44). The mean transfusion requirement in the hepar in group (1.8 units of packed red blood cells) was significantly greater th an that in the control group (0.8 unit) (p < 0.0001). Three of the four pat ients who had a bleeding complication while receiving heparin and warfarin had coagulation parameters that were substantially higher than recommended levels. The mean duration of hospitalization in the heparin group (fifteen days) was significantly longer than that in the control group (seven days) (p < 0.0001). Conclusions: The results of the present study suggest that the, use of intr avenous heparin therapy for the treatment of thromboembolism in the early p ostoperative period after total joint arthroplasty is associated with a: ra te of bleeding complications that is similar to that associated with the us e of prophylactic anticoagulation with use of enoxaparin alone. One should expect an increased transfusion requirement and a longer duration of hospit alization for patients who require intravenous heparin therapy for the trea tment of a thromboembolic event.