التمييع الوقائي بعد تبديل مفصل الركبة البدئي

Background and Objective: The rate of venous thromboembolism is unacceptable without prophylaxis. Venographic studies of patients without prophylaxis show that the deep vein-thrombosis rates range from 40-84% after total knee replacement, and rates of pulmonary embolism range from 1.5-10%. Surgeons must balance the need for thromboprophylaxis with the need to avoid bleeding complications. The purpose of this study is to evaluate the status of thrombo prophylaxis after primary total knee replacement in ALMouassat university hospital, and to improve our outcome in future, to get better results and fewer complications. Material & Method: this was a retrospective study, results of prophylaxis were evaluated in 93 total knee replacement (80 Patients) from 22/1/2009 to 7/3/2010, all of those patients received enoxaparin 40mg sc, 12 hours before surgery and 12 hours after, then once daily, for 30 days. Results: the rate of symptomatic DVT in this study was 2.15%, and 1.075% for PE, these rates are similar to published studies. But the rate of wound complications is very high in our study 17.2%, and the rate of deep infection is 4.3%. There was a lack in patients' preoperative evaluation, absence of guideline ,longer period of prophylaxis than recommended, and absence of mechanical prophylaxis devices which can be used with less prophylaxis medication or instead of it. Conclusion: Patients should be assessed preoperatively for elevated risk with regards to bleeding and DVT/PE and be treated according to individual risk.