Thrombosis prevention after total hip arthroplasty: a prospective, randomized trial comparing a mobile compression device with low-molecular-weight heparin.

The authors compared the efficacy and safety of a mobile compression device to standard low-molecular-weight heparin (LMWH) administration for the prevention of thromboembolic (TE) complications in 410 patients (414 hips) undergoing total hip replacement (THR) surgery. The rates of venous TE events were similar in both groups (5%). Bleeding events were more frequent in the LMWH group but transfusions were similar in both groups.

While the results would appear to support the use of a mobile compression device, it should be noted that the study was not powered for efficacy (as acknowledged by the authors) and that bleeding events were driven by the inclusion of anemia in the definition of bleeding (5 out of 11 major bleeds). Finally, the feasibility of wearing a compression device continually for an extended period of time remains to be demonstrated (battery power is restricted to 6 hours and patients removed the device 4 hours per day because of discomfort).

Thus, this article does not support the interchangeability of a mobile compression device with the administration of LMWH (the gold standard to this day) for the prevention of TE events after THR. Orthopedic surgeons are afraid of excessive bleeding but the consequences of major TE events cannot be understated.

– Jean-Franois Hardy