INCIDENCE OF POST OPERATIVE THROMBOEMBOLIC Disoders IN GERIATRIC PATIENTS SUBJECTED TO TOTAL HIP OR KNEE REPLACEMENT USING GENERAL VERSUS REGIONAL ANAESTHESIA TECHNIQUE AFTER PROPHYLAXIS WITH LOW MOLECULAR WEIGHT HEPARIN

Abstract

Geriatric patients undergoing major orthopedic procedures of the hip or knee represent a population at great risk for DVT and PE. It is important to consider the relationship between the reduction of thromboembolic complications and the use of regional anesthesia. It has been shown that deep venous thrombosis (DVT) can be reduced with the use of regional anesthesia in joint replacement surgeries.

However, regional anesthesia alone is not considered a totally effective prophylactic measure, low molecular weight heparins (LMWH)s are a recently used drugs for thrombo prophylaxis in elderly patients planed for hip or knee replacement. LMWHs have bioavailability of greater than 90% following subcutaneous administration. This predictable anticoagulant response is realized with fixed prophylactic doses, long half life, and less incidence of complications

This study was conducted on included 60 geriatric patients subjected to either total hip or total knee replacement surgeries. These patients divided into three groups according to the applied anesthesia.

• First Group (20 patients) was performed under General Anesthesia

•Second Group (20 patients) was performed under Epidural Anesthesia

•Third Group (20 patients) was performed under Spinal Anesthesia

All these patients received a LMWH as a thrombophylactic measure 12 hours before and four days after the surgery.

The patients in the Three groups were subjected to the following:

• Measures for DVT detection by clinical assessment, duplex scanning and MR venography

• Measures for PE detection by clinical assessment, chest X-ray, ECG and perfusion lung scanning (if there was any suspicion).

• Assessment of bleeding tendency by daily observation and follow up for any bleeding manifestations including epidural hematoma in patients who received epidural anesthesia

• Laboratory work measuring complete blood count, APTT, and anti Xa activity if there was unexplained bleeding.