Incidence and Prevention of Thromboembolic Events in One Stage Bilateral Total Hip Arthroplasty: A Systematic Review

George      C. Babis; Vasileios      I. Sakellariou; Elizabeth      O. Johnson; Panayotis      N. Soucacos

Abstract

We conducted a thorough search of all the English language literature and carried out a meta-analysis in an attempt to reveal potential differences on the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) between one stage bilateral and unilateral total hip replacements, and to provide, if possible, recommendations on thromboembolic prophylaxis. We identified 37 citations eligible for inclusion. A total of 5868 bilateral simultaneous THR patients were identified. Analysis of data was performed with the Mantel-Haenszel method. Meta-analysis of homogeneous data revealed no statistically significant differences in the rates of deep vein thrombosis (p = 0.40) and pulmonary embolism (p = 0.39) when comparing staged with bilateral simultaneous THR procedures as well as the rates of pulmonary embolism when comparing bilateral simultaneous THR with unilateral procedures (p = 0.69). However, deep vein thrombosis rate was in favor of bilateral two-stage compared to unilateral THR (p = 0.00001). Definite recommendations regarding the prevention of thromboembolic events in bilateral simultaneous THR could not be produced as the literature was limited and the data heterogenic. Conclusively, deep vein thrombosis and pulmonary embolism is not increased in bilateral simultaneous THR, provided that appropriate prophylactic measures are taken. More data are needed in order to clarify if additional measures or altered protocols of thromboembolic prophylaxis should be followed.

Keywords: Bilateral hip replacement, deep vein thrombosis, pulmonary embolism, Thromboembolic, deep vein thrombosis (DVT), pulmonary embolism (PE), Mantel-Haenszel method, coagulation cascade, Medline, Cochrane, Web of Knowledge, Ovid, bilateral simultaneous, unilateral THR, prostheses, interval (CI), antithrombotic, warfarin, aspirin, Coumadin, retrospective, prospective, enoxaparin, American Society of Anes-thesiologists (ASA), hypoxaemia, prophylactic, prophylaxis regi-men, low-molecular-weight heparin (LMWH), synthetic pentasaccharides, normalized ratio (INR), dipyridamole, dogrele bisulphate, intermittent pneumatic calf compres-sion, asymptomatic, meta-analysis of thromboembolic prophylaxis, chemoprophylactic agents, chemoprophylaxis, factor IIa, factor Xa (FXa), dabigatran etexilate (BIBR 1048), AZD0837, flo-vagatran sodium, rivaroxaban (BAY 59-7939), apixaban, betrixaban, YM150, DU-176b, LY-517717, GW813893, PD 0348292