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Is Low-Molecular-Weight Heparin Suitable in All Patients Undergoing Knee Arthroplasty?
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 for asymptomatic calf deep venous thrombosis (DVT) and has never been validated as an outcome measure after arthroscopy (46).
Second, the distribution of calf DVT and muscular venous thromboses for each treatment group is not …
