Prevention of symptomatic thrombosis with short term (low molecular weight) heparin in patients with rheumatoid arthritis after hip or knee replacement

The need for prevention of venous thromboembolism. (VTE) after total hip or knee replacement is obvious. However, the optimal regimen to achieve this remains to be defined. In patients with rheumatoid arthritis (RA) long term coumarins may not be necessary owing to the use of non-steroidal anti-infl ammatory drugs (NSAIDs). 103 patients in whom 151 surgical procedures were performed (55 hip and 96 knee prostheses) were treated only with short term subcutaneous heparin. NSAIDs were used daily in 85% of the patients, and t hey were continued after hospital discharge. Only one patient developed sym ptomatic deep venous thrombosis during one year follow up. Bleeding complic ations were seen in 20/151 (13%) of the surgical procedures, all clinically judged as minor, and recovery was not delayed except in one case. Short te rm (low molecular weight) heparin appears to be an adequate, simple, and sa fe method for prevention of symptomatic VTE in patients with RA after knee or hip replacement, though further studies are necessary to confirm these p reliminary findings.