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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n\u003Cp id=\u0022p-1\u0022\u003EIn a prospective trial among patients who underwent elective total knee or hip replacement, pneumatic compression devices and warfarin were both effective in preventing thrombolic events. Bleeding events, wound complications, and drainage were significantly higher among those on warfarin. Patient satisfaction was higher among those with a pneumatic compression device.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EVTE\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDVT\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epulmonary embolism\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ewarfarin\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epneumatic compression device\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EIPCD\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ehip arthroplasty\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eknee arthroplasty\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eorthopaedics \u0026amp; sports medicine clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ehip \u0026amp; knee conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eorthopaedic procedures\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n\n\u003Cp id=\u0022p-2\u0022\u003EVenous thromboembolism (VTE) is the most common complication of total knee arthroplasty (TKA) and total hip arthroplasty (THA). It is estimated that approximately 1 in 100 patients undergoing TKA and approximately 1 in 200 patients undergoing THA develop symptomatic VTE following surgery [Januel JM et al. \u003Cem\u003EJAMA\u003C\/em\u003E. 2012].\u003C\/p\u003E\n\u003Cp id=\u0022p-3\u0022\u003EThe American Academy of Orthopaedic Surgeons has issued recommendations for VTE prophylaxis that include the use of various pharmacologic agents and\/or intermittent pneumatic compression devices (IPCDs) for patients undergoing elective TKA or THA who have no additional risks for VTE or bleeding beyond the surgery itself [Jacobs JJ et al. \u003Cem\u003EJ Bone Joint Surg Am\u003C\/em\u003E. 2012]. The American College of Chest Physicians guidelines have also expanded their recommendations and now include the use of an IPCD, with the caveat that it be portable, battery powered, and able to monitor on a daily basis whether the patient wears the device and for how long [Falck-Ytter Y et al. \u003Cem\u003EChest\u003C\/em\u003E. 2012].\u003C\/p\u003E\n\u003Cp id=\u0022p-4\u0022\u003EWhile warfarin is commonly prescribed to prevent VTE following TKA and THA, it has a narrow therapeutic index, can cause severe bleeding, requires frequent monitoring, and is associated with food and drug interactions. Ryan M. Nunley, MD, Washington University School of Medicine, St Louis, Missouri, USA, described a prospective study designed to compare the safety and efficacy of a mobile IPCD compared with warfarin therapy for the prevention of VTE among patients undergoing TKA and THA. A second goal was to evaluate whether patients were satisfied with the treatment they received.\u003C\/p\u003E\n\u003Cp id=\u0022p-5\u0022\u003EThe study included 2722 adults undergoing elective primary or revision TKA or THA (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). Patients were stratified to either a standard-risk (n\u2005=\u20051888) or high-risk (n\u2005=\u2005834) VTE prophylaxis for 6 weeks postoperatively, depending on the local treatment protocol. In the standard-risk protocol, patients wore an IPCD for 10 days and took aspirin 325 mg twice daily for 6 weeks. High-risk patients received 4 weeks of dose-adjusted warfarin and wore compression stockings for 6 weeks.\u003C\/p\u003E\n\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16276\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16276\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16276\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EStratification by Treatment Protocol and Type of Procedure\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-8\u0022\u003EIneligibility criteria included prior surgery within 3 months, preoperative deep vein thrombosis (DVT), history of pulmonary embolism (PE), chronic anticoagulation therapy, and prolonged immobilization following surgery.\u003C\/p\u003E\n\u003Cp id=\u0022p-9\u0022\u003EPostoperatively, patients were monitored for bleeding complications, symptomatic VTE, and hospital readmissions. At 4 to 6 weeks, there were no significant differences in the rate of DVT\/PE in the standard- vs high-risk groups, TKA vs THA, or primary vs revision surgery (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E). Patients in the high-risk group experienced significantly more drainage postoperatively compared with the low-risk group (21% vs 14%, respectively; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.001). Major bleeding events were significantly higher in the high-risk group than in the standard-risk group (2% vs 0.3%, respectively; \u003Cem\u003EP\u2005\u003C\/em\u003E\u0026lt;\u2005.001); the high-risk group also experienced more wound problems (1.3% vs 0.2%, respectively; \u003Cem\u003EP\u2005\u003C\/em\u003E=\u2005.002). Overall, patients who received the IPCDs were more satisfied with their treatment than those who received high-risk anticoagulation therapy (\u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.001).\u003C\/p\u003E\n\u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16277\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16277\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16277\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EComparison of DVT\/PE Rates at 6 Weeks\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-13\u0022\u003EIn conclusion, IPCDs and warfarin were similarly effective in preventing VTEs. However, patients with an IPCD experienced significantly fewer major bleeding events, wound complications, and days of drainage. In addition, patients were more satisfied with IPCD treatment than warfarin treatment.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/7\/6.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlpmq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzlpmq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}