Prevention of thromboembolic phenomena.

The leading cause of death from total hip replacement is pulmonary embolism. Prophylactic anticoagulation has been effective in decreasing thromboembolic phenomena but has been associated with a high rate of complications. A low dose warfarin prophylaxis combined with anti-embolic hose, elevation of the legs and early ambulation was employed in 415 total hip replacements. Clinical thrombosis occurred in 2.4 per cent and there was 1.45 per cent pulmonary emboli but none resulted in death. Two deaths from non-embolic causes occurred for a mortality rate of 0.49 per cent. Systemic complications of the warfarin were few with 5 mild gastroentestinal hemorrhages but no deaths related to the medication. Wound hemorrhage occurred in 4.6 per cent of patients and it is recommended that severe, deep superficial hematomas be treated with early surgical evacuation. The management program appeared to be safe and effective in preventing postoperative mortality from pulmonary emboli but close monitoring is essential.