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Orthopaedics & Traumatology: Surgery & Research
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le jeudi 14 mars 2019
Doi : 10.1016/j.otsr.2018.12.012
Received : 9 August 2018 ;  accepted : 17 December 2018
Routine monitoring for heparin-induced thrombocytopenia following lower limb arthroplasty: Is it necessary? A prospective study in a UK district general hospital
 

Benjamin Haughton a, Joanna Haughton b, John George Norman c, , Ahmad Navid d, Kathy Allport a, Mark Andrews a, Ken Mannan a, Jonathan Livesey a
a York Hospital NHS Foundation Trust, Wiggington Road, York, YO31 8HE, United Kingdom 
b The Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, WF1 4DG, United Kingdom 
c Hull York Medical School, John Hughlings Jackson Building, University of York, Heslington, York, YO10 5DD, United Kingdom 
d Health Education England: West Midlands, St Chads Court, 213 Hagley Road, Edgbaston, Birmingham, B16 9RG, United Kingdom 

Corresponding author. Hull York Medical School, John Hughlings Jackson Building, University of York, Heslington, York, North Yorkshire, YO10 5DD, United KingdomHoly Trinity Rectory, 81 Micklegate, YORKNorth YorkshireYO1 6LEUnited Kingdom
Abstract
Introduction

Heparin-induced thrombocytopenia (HIT) is a potentially life-threatening condition associated with heparin administration. Many orthopaedic units routinely prescribe low-molecular-weight heparins as thromboprophylaxis after hip and knee arthroplasty.

Hypothesis

We postulated that routine platelet monitoring following heparin administration is of no clinical benefit. We therefore asked: firstly, what was the rate of thrombocytopenia in a large population of patients undergoing lower limb arthroplasty? Secondly, did this rate justify routine platelet monitoring?

Materials and methods

Unless contraindicated, all patients (n =1999, 53.05% female, mean age 69.23 years) at a UK district general hospital undergoing hip and knee arthroplasty were given daily prophylactic enoxaparin. Platelet counts were obtained between the 8th and 10th postoperative days and compared to preoperative baseline. A > 50% fall in platelet count was classified as “possible HIT”. The minimal acceptable risk of thrombocytopenia was defined using The American College of Chest Physicians (ACCP) 2012 guidelines, which recommend monitoring platelet counts in patients receiving heparin where the expected risk of HIT is>1% and by descriptive cost-benefit analysis based on the cost of routine platelet monitoring in the clinical setting.

Results

Complete results were available for 1361 (68.1%) patients, comprising: 653 primary hips, 22 revision hips, 1 hip resurfacing, 665 primary knees, 19 revision knees and 1 unicompartmental knee replacement. Mean platelet level was 281.9×109/L preoperatively and 527.83×109/L postoperatively. Forty-four patients (3.2%) experienced a postoperative fall in platelet levels. However, no patient experienced a drop in platelets to less than 50% of the preoperative value.

Discussion

The incidence of HIT in the elective arthroplasty population is low. Therefore, routine postoperative monitoring of platelets is not necessary in this population of patients.

Level of evidence

II, prospective study.

The full text of this article is available in PDF format.

Keywords : Heparin-induced thrombocytopenia, Low-molecular weight heparin, Hip, Knee, Arthroplasty




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