Thromboembolic disease in patients with rheumatoid arthritis undergoing joint arthroplasty: Update on prophylaxes

Table 1 Summary of the 8 articles selected for inclusion in systematic review

Ref.	Study design	Operation	RA patients	Methods of prophylaxis	Duration of prophylaxis	Methods of surveillance	VTE	EP	Bleedingcomplications
van Heereveld et al[5]	Retrospective open study of all medical record of patients with RA who underwent a Hip or Knee replacement from Jan 1987 to April 1995	THA and TKA	103 patients with RA who underwent 151 surgical procedure 55 (TKRH) 96 (THR)	Subcutaneous SH 5000 UI twice a day, starting two-six ours before surgery and was given twice a day, or nadroparin 7500 IC-U (10.000-20.00 IC U for obese patients) once a day. NSAIDs in 85% daily and continued after hospital discharge	For a minimun of 7 d and discontinued as soon as patient was adequately mobilized	Sonography, phlebography and V/Q scanning only in patients with clinical suspicion of VTE or PE The patients were seen every three months. the total of follow up was one year	1	0	20/151 (13%) Fifteen haematoma necessitating blood transfusion in six cases In one instance a surgical decompression was made. In none of bleeding episodes were signs of haemodynamic instability
Niki et al[6]	Prospective study of 333 patients who underwent primary TKA between October 2003 and June 2007 with diagnosis of RA and OA	TKA	199 (238 KNEES)	LOW dose unfractionated heparin (5000 U) for when patients had history of DVT or D-Dimer levels > 10 g/mL)	From second to eight day post-discharge	Sonography (pre-operatively and on POD 7), d-dimer on POD 0, 1 and 7	51	1	1
Sharrock et al[7]	Retrospective review of 571 primary TKA in epidural anesthesia between July 1986 to June 1990	TKA	54 RA	Aspirin (650 mg) and elastic streaking	5 d	Venography at forty and fifty post operative day	21 (39%)	Not reported	Not reported
Swiestra et al[8]	Retrospective randomized study of 101 consecutive patients admitted for primary THA	THA	14 RA	Acenocumarol started four or one day preoperatively aiming a thrombotest of 25% during the operation (1.5-1.6 INR)	Discontinuation of anticoagulation after negative venogram	Venography with 99mtc labeled macroaggregates of albumin, performed about 10 d after the operation for identifying proximal DVT	23/101	1 patient post-discharge	2 bleeding complication associated to excessively prolonged protrombine time
White et al[9]	Retrospective analysis of in hospitality mortality and morbidity of 721 RA vs 8859 OA patients who underwent a non emergent THR from 1984 to 1985	THA	721 RA	Not reported	Not reported	Not reported	0.3 % of VTE vs 1.2% in OA patients		4.20%
Nagase et al[10]	Retrospective analysis of 27542 patients who underwent THA or TKA in 723 japan hospital between 2007 and 2008	THA/TKA	2153 RA	Mechanical prophylaxis or mechanical prophylaxis and fondaparinux	Not reported	Not reported	19 (0.89%)		Not reported
Soohoo et al[11]	reviewed discharge data from 138399 patients undergoing primary THA in California from 1995 to 2005	THA	5565 RA	Not reported	Not reported	Not reported	OR = 1.46 (95%CI: 0.82-1.61; P = 0.2)		Not reported
Hull et al[12]	A randomized trial was performed in 310 consecutive patients undergoing total hip replacement between 1978 and 1986	THA	77 RA	Sequential calf and thigh intermittent compression was begun postoperatively in the recovery room compared with none prophylaxis	Intermittent compression was continued until the patient was discharged from the hospital or for 14 d, at which time most patients were fully ambulant	Leg scanning was performed on the first day after surgery and then daily for 14 d	None prophylaxis: 77/158 Intermittent leg pneumatic compression: 36/152		Not reported

VTE: Venous thromboembolism; RA: Rheumatoid arthritis; THA: Total hip arthroplasty; TKA: Total knee arthroplasty; POD: Postoperative days; OA: Osteoarthritis.