Is Low-Molecular-Weight Heparin Suitable in All Patients Undergoing Knee Arthroplasty?
Authors: William Geerts
Journal: Annals of Internal Medicine (2008)

Letters4 November 2008Is Low-Molecular-Weight Heparin Suitable in All Patients Undergoing Knee Arthroplasty?William Geerts, MDWilliam Geerts, MDFrom Sunnybrook Health Science Centre, Toronto, Ontario M4N 3M5, Canada.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-149-9-200811040-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Camporese and colleagues (1) reported the results of the KANT (Knee Arthroscopy Nadroparin Thrombophylaxis) trial and concluded that thromboprophylaxis with low-molecular-weight heparin (LMWH) should be offered to all patients undergoing knee arthroplasty. This recommendation differs from the American College of Chest Physicians (ACCP) evidence-based guidelines on the prevention of venous thromboembolism (VTE), which recommend against the routine use of thromboprophylaxis after knee arthroscopy (2, 3). I have some concerns about the KANT trial, and my interpretation of the results differs from those of the authors.First, the accuracy of Doppler ultransonography has been shown to be suboptimal ...References1. Camporese G, Bernardi E, Prandoni P, Noventa F, Verlato F, Simioni P; KANT (Knee Arthroscopy Nadroparin Thromboprophylaxis) Study Group. Low-molecular-weight heparin versus compression stockings for thromboprophylaxis after knee arthroscopy: a randomized trial. Ann Intern Med. 2008;149:73-82. [PMID: 18626046] LinkGoogle Scholar2. Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW; Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126:338S-400S. [PMID: 15383478] CrossrefMedlineGoogle Scholar3. Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR; American College of Chest Physicians. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133:381S-453S. [PMID: 18574271] CrossrefMedlineGoogle Scholar4. Schellong SM, Beyer J, Kakkar AK, Halbritter K, Eriksson BI, Turpie AG; Ultrasound screening for asymptomatic deep vein thrombosis after major orthopaedic surgery: the VENUS study. J Thromb Haemost. 2007;5:1431-7. [PMID: 17419763] CrossrefMedlineGoogle Scholar5. Goodacre S, Sampson F, Thomas S, van Beek E, Sutton A. Systematic review and meta-analysis of the diagnostic accuracy of ultrasonography for deep vein thrombosis. BMC Med Imaging. 2005;5:6. [PMID: 16202135] CrossrefMedlineGoogle Scholar6. Kassa B, Boissel JP, Cucherat M, Sonie S, Shah NR, Leizorovicz A. A systematic review of the accuracy of ultrasound in the diagnosis of deep venous thrombosis in asymptomatic patients. Thromb Haemost. 2004;91:655-66. [PMID: 15045125] CrossrefMedlineGoogle Scholar7. Camporese G, Bernardi E, Prandoni P; Graduated compression stockings (GCS) versus low-molecular-weight heparin (LMWH) for prevention of deep vein thrombosis (DVT) after knee arthroscopy (KA). A randomized study (KANT) [Abstract]. J Thromb Haemost. 2007;5 Suppl 2 O-T-052. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Sunnybrook Health Science Centre, Toronto, Ontario M4N 3M5, Canada.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLow-Molecular-Weight Heparin versus Compression Stockings for Thromboprophylaxis after Knee Arthroscopy Giuseppe Camporese , Enrico Bernardi , Paolo Prandoni , Franco Noventa , Fabio Verlato , Paolo Simioni , Kadimashi Ntita , Giovanna Salmistraro , Christos Frangos , Franco Rossi , Rosamaria Cordova , Francesca Franz , Pietro Zucchetta , Dimitrios Kontothanassis , Giuseppe Maria Andreozzi , and Is Low-Molecular-Weight Heparin Suitable in All Patients Undergoing Knee Arthroplasty? Giuseppe Camporese , Franco Noventa , and Enrico Bernardi Metrics Cited byReisen während der Schwangerschaft 4 November 2008Volume 149, Issue 9Page: 687KeywordsArthroplastyArthroscopyClinical trialsHemorrhageKneesPulmonary embolismThoraxThrombosisVenous thromboembolism ePublished: 4 November 2008 Issue Published: 4 November 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...