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1 April 1998 | Volume 128 Issue 7 | Page 601
It is interesting that Robinson and colleagues' study [1] shows a rate of deep vein thrombosis after hospital discharge (2.5%) that is lower than the rates reported by Planes [2] and Bergqvist [3] and their colleagues. The main reason for the lower incidence in Robinson and coworkers' study is the inclusion of only proximal deep venous thrombosis as diagnosed by ultrasonography. In contrast, the other two studies included both proximal and distal deep venous thrombosis diagnosed by venography. The incidence of proximal deep venous thrombosis is similar in all three studies, but undiagnosed distal deep venous thrombosis (which is asymptomatic) occurred in approximately 10% of patients in the other two studies. Distal deep venous thrombosis is clinically important because it can increase risk for proximal deep venous thrombosis and the postphlebitic syndrome. Robinson and colleagues did not consider these conditions. We agree that there is no need for screening at hospital discharge, but we believe it is important to continue prophylaxis with low-molecular-weight heparin or coumarin for up to 6 to 8 weeks. This regimen has been shown to be safe and effective in reducing risk for both proximal and distal deep venous thrombosis.
1. Robinson KS, Anderson DR, Gross M, Petrie D, Leighton R, Stanish W, et al. Ultrasonographic screening before hospital discharge for deep venous thrombosis after arthroplasty: The Post-Arthroplasty Screening Study. A randomized, controlled trial. Ann Intern Med. 1997; 127:439-45.
2. Planes A, Vochelle N, Darmon JY, Fagola M, Bellaud M, Huet Y. Risk of deep-venous thrombosis after hospital discharge in patients having undergone total hip replacement: double-blind randomised comparison of enoxaparin versus placebo. Lancet. 1996; 348:224-8.
3. Bergqvist D, Benoni G, Bjorgell O, Fredin H, Hedlundh U, Nicolas S, et al. Low-molecular-weight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement. N Engl J Med. 1996; 335:696-700. About Letters
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LETTER
Ultrasonographic Screening for Deep Venous Thrombosis after Arthroplasty
TO THE EDITOR:
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Robert Wood Johnson Medical School; Camden, NJ 08103
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