The value of ultrasound screening for proximal vein thrombosis after totalhip arthroplasty - A prospective cohort study

The role of ultrasound screening for proximal deep-vein thrombosis (DVT) fo llowing major hip surgery is controversial. 202 consecutive patients, who h ad received warfarin prophylaxis after total hip arthroplasty underwent a b ilateral ultrasound assessment of the proximal vein system (using the crite rion of vein compressibility) before hospital discharge. In the 9 patients (4.5%; 95% Cl, 2.1-8.3%) with positive test anticoagulant treatment was suc cessfully continued for three months. In all the remaining 193 patients the warfarin treatment was withdrawn. A second ultrasound test was performed 1 5 days later, and showed a new (asymptomatic) abnormality compatible with p roximal DVT in 2 patients (1.0%; 95% Cl, 0.1-3.7%). All other 191 patients remained asymptomatic until the completion of a 3-month follow-up period (r ate of symptomatic thromboembolism, 0/191, 0% 95% Cl, 0-1.9%). Because of the relatively high incidence of proximal DVT in patients underg oing major orthopaedic surgery under warfarin prophylaxis, screening for pr oximal DVT at hospital discharge in these patients is indicated. The negati vity of this test has the potential of safely preventing the extension of a nticoagulation beyond hospital stay. A larger controlled study in which the value of this strategy is tested against the prolongation of oral anticoag ulation in patients with a negative ultrasound screening at discharge is in dicated.