A comparative analysis of the association between prolonged wound site discharge amd venous thromboembolism prophylaxis methods after hip and knee prosthesis

Objective:The aim of the present study was to compare clinical outcomes of discontinuation of Low Molecular Weight Heparin (LWMH) used for Venous Thromboembolism (VTE) prophilaxis and use of Acetylcalycyclic Acid (ASA) which has less discharge effect, and continuing LWMH treatment together with negative pressurized wound dressing for he treatment of prolonged wound site discharge which may be observed after hip and knee prothesis surgery. Material and Method: This prospective study included patients with prolonged wound site discharge (>72 hours) who were treated by LMWH for venous thromboembolism prophylaxis after knee prosthesis or hip prosthesis in Orthopaedics and Traumatology Clinic between February, 15, 2019 and February, 15, 2020. The participants were divided into two groups randomly including those whose LMWH treatment was replaced by ASA treatment (Group 1), and those whose LWMH treatment continued and negative pressurized dressing was also placed (Group 2). Demographic characteristics, operation indications, quality of the drained fluid, leak periods, thromboembolic event, deep vein thrombosis (DVT) and 3-month complications of groups were compared. Furthermore, factors affecting the wound site durations were reviewed. Findings: The age average of the patients enroleld into the study was 71±9.4 years; 67.5% of the participants were female. There was not any difference between groups for age and gender (p:0.201, p:0.736, respectively). The most common diagnosis was primary gonarthrosis (35%) and the most common indication for operation was total knee prosthesis (35%). There was not any difference between groups for smoking, alcohol, BMI, and systemic disease (p: 0.677; p:N/a; p:0.461; p:0.168, respectively).There was not any difference between groups for preoperative (pre-op) INR, pre-op white bood cell (WBC), pre-op albumin, and pre-op platelet (p:0.157, p:0.051, p:0.429, p:0.883, respectively). There was not any difference between groups for the quality of the fluid discharged (p:0.915). Furthermore, the active wound site durations were 78.8±26.8 hours and 64±20.7 hours in Group 1 and Group 2, respectively. The active wound site duration was significantly shorter in Group 2 (p:0.026). There was not any significant difference between active wound site discharge duration and age, gender, BMİ, smoking, systemic disease (p: 0.974; p: 0.648, p:0.682, 0.651, p:0.550, respectively).A positive correlation was detected between active wound site discharge duration and pre-op INR and WBC level (p:0.046, p:0.026, respectively). There was not any significant difference between active wound site discharge duration and the quality of discharged fluid (p:0.947). There was not any significant difference between active wound site discharge duration and operation area, and etiology (p:0.507, p: 0.211, respectively). There was not any difference between groups for within 3 months postoperatively (post-op) history of thromboembolic event, and development of DVT (p:0.667, p:0.487, respectively). The prevalence of 3-month complication rate was detected higher in Group 1 (p: 0.046). There was not any significant difference between active wound site discaharge duration within 3 months post-op history of thromboembolic event, development of DVT, and complications (p:0.285, p: 0.185, p: 0.147, respectively). Key Words: total knee prosthesis, total hip prosthesis, Aspirin, low molecular weight heparin, negative pressurized dressing, prolonged wound site discharge