THE INCIDENCE OF DEEP VEIN THROMBOSIS IN ORTHOPAEDIC PATIENTS UNDERGOING MAJOR LOWER LIMB SURGERIES WITH OR WITHOUT THROMBOPROPHYLAXIS: A COMPARATIVE STUDY

BACKGROUND There is paucity of data regarding the development of Deep Vein Thrombosis (DVT) without prophylaxis compared with thromboprophylaxis in Indian population. OBJECTIVE To evaluate the requirement of thromboprophylaxis, complications of therapy, its advantages and disadvantages in patients undergoing major orthopedic surgeries of lower limb. METHOD This comparative study was conducted in 164 patients; preoperatively patients were screened, categorized into high risk and low risk groups. Randomly selected patients received prophylactic antithrombotic therapy (Category A), while others did not (Category B). Patients were closely monitored for DVT and pulmonary embolism. Colour Doppler was done for all on 5th to 7th postoperative day or till active ambulation. RESULT Mean age of the patients was 52 yrs. Patients in high risk group were 62 (37.8%). Major surgeries included Dynamic Hip Screw for trochanteric and basic cervical fractures in 68 (41.4%) patients and hemiarthroplasty with bipolar and Austin Moore prosthesis for fracture neck of femur in 36 (21.9%). Median length of inpatient stay was 08 days with median time required for ambulation 07 days. Of 71 patients in Category-A, eight (11.2%) were clinically symptomatic for DVT, of which only two (2.8%) had positive Colour Doppler. Of 93 patients in Category-B, 40 (43%) were symptomatic and seven (7.5%) had positive colour Doppler. Excessive blood loss was recorded in 14 patients in Category -B. There were three deaths in the high risk patients (02-Category-B). CONCLUSION Primary thromboprophylaxis with LMWH decreased post-surgical complications. In spite of increased blood loss, thromboprophylaxis is worth considering.