Safety of a clinical surveillance protocol with 3-and 6-week warfarin prophylaxis after total joint arthroplasty

The charts of 1869 patients were reviewed for the occurrence of deep venous thrombosis (DVT) and pulmonary embolism after total hip or knee arthroplas ty. Prophylaxis consisted of 3 (group 1; n=1235) or 6 (group 2; n=634) week s low-dose warfarin, pneumatic compression boots worn by patients in the ho spital, mobilization on the first postoperative day, and a clinical surveil lance protocol. Venous ultrasound or ventilation/perfusion lung scintigraph y (V/Q) was performed only if patients became symptomatic. In group 1, duplex ultrasound was performed on 216 patients. Twenty-three ( 1.8%) patients were positive for DVT. Ventilation/perfusion lung scintigrap hy was performed on 25 patients, and 5 (0.4%) patients were positive for pu lmonary embolism. In group 2, 117 patients were evaluated for DVT, and 19 ( 3%) patients had positive results determined by ultrasound. Twenty-five pat ients were evaluated with V/Q, and only 1 (0.16%) patient was positive for pulmonary embolism. No patient developed a fatal pulmonary embolism or post phlebitic syndrome. This prophylaxis protocol is an efficient and. cost-eff ective method for the prevention of significant events after surgery.