Literature at a Glance
- Postoperative prophylactic LMWH should be considered for arthroscopic knee surgery patients.
- Individualized therapy is required for DVT prophylaxis in the neurosurgical patient.
- SMART-COP is a reasonable screening tool for ICU admission.
- Mediterranean and low-carb diets are safe and effective alternatives to low-fat diets.
- Admissions for ACS in both smokers and non-smokers decrease after implementation of smoking ban.
- Beta-blockers should be continued whenever possible in patients hospitalized for heart failure with LVSD.
- Non-invasive ventilation improved dyspnea, but did not improve short-term mortality rates in patients with acute cardiogenic pulmonary edema.
- COX-2 inhibitors should be used with caution in patients with increased cerebrovascular disease risk.
Clinical question: Does low molecular weight heparin (LMWH) prevent venous thromboembolism (VTE) compared to compression stockings without increasing bleeding complications in arthroscopic knee surgery?
Background: Knee arthroscopy is a common orthopedic surgery and postoperative venous thromboprophylaxis is not routinely recommended.
Study design: Randomized, controlled trial with blinding of the investigators.
Setting: Single orthopedic clinic in Italy, with followup at a university hospital.
Synopsis: 1,761 consecutive patients undergoing knee arthroscopy were randomly assigned to full-length graduated compression stockings (CS) for seven days postoperatively, subcutaneous LMWH (nadoparin 3800 units daily) for seven or 14 days postoperatively. The primary outcome of asymptomatic proximal deep venous thrombosis (DVT), symptomatic VTE, and all-cause mortality within three months of surgery was higher with CS (3.2%) than with LMWH for seven or 14 days (0.9% in each group) (P=0.005). There was no significant difference in bleeding events between groups.
The study was underpowered to detect differences in bleeding risk. Furthermore, almost half the events making up the primary outcome were distal DVTs of uncertain clinical significance. Notably, the 14-day LMWH group was discontinued early because of unspecified safety concerns related to longer exposure to LMWH.
Bottom line: Postoperative prophylactic LMWH for seven days may prevent some thromboses after knee surgery and should be considered in higher-risk patients.
Citation: Camporese G, Bernardi E, Prandoni P, et al. Low-molecular-weight heparin versus compression stockings for thrombophylaxis after knee arthroscopy. Ann Intern Med. 2008;14(9):73-82.