Risk factors for deep vein thrombosis even using low-molecular-weight heparin after total knee arthroplasty

Knee Surgery & Related Research - 2021
Joon Kyu Lee1, Kee Byoung Lee2, Joong Il Kim3, Gun Tae Park4, Young Chang Cho1
1Department of Orthopaedic Surgery, Konkuk University Medical Center, 120-1, Neungdong-ro, Gwangjin-gu, Seoul, 05030, South Korea
2Department of Orthopaedic Surgery, Cheongju St. Mary’s Hospital, 173-19 Jusung-ro, Cheongwon-gu, Cheongju-si, Chungcheongbuk-do, 28323, South Korea
3Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 07741, South Korea
4Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro, 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, South Korea

Tóm tắt

AbstractBackgroundWith an increase in deep vein thrombosis (DVT) following total knee arthroplasty (TKA) in the Asian population, most surgeons today use a form of prophylactic anticoagulant agents in patients after TKA. Nevertheless, DVT occasionally develops even in these patients with prophylaxis. The purpose of this study was to identify the risk factors for DVT after TKA in cases of postoperative low-molecular-weight heparin (LMWH) use.MethodsWe designed a retrospective study with 103 patients who underwent primary TKA. From the second postoperative day, 60 mg of LMWH was subcutaneously injected into the patients daily. On the seventh postoperative day, patients had computed tomography angiography to check whether they had DVT. Regarding risk factors, we investigated patients’ gender, age, surgical site (unilateral/bilateral), body mass index, method of anesthesia, preoperative hypertension, diabetes, hypercholesterolemia status, and prothrombin time/international normalized ratio from electronic medical records. We analyzed the statistical significance of these risk factors.ResultsStatistically significant factors in the single-variable analysis were surgical site (unilateral/bilateral), body mass index, preoperative hypertension status, and anesthesia method. Multiple logistic regression analysis with these factors revealed that the surgical site (unilateral/bilateral,p = 0.024) and anesthesia method (p = 0.039) were significant factors for the occurrence of postoperative DVT after TKA.ConclusionsPatients undergoing simultaneous bilateral TKAs and patients undergoing TKA with general anesthesia need more attention regarding DVT even with chemoprophylaxis using LMWH after TKA.

Từ khóa


Tài liệu tham khảo

Piovella F, Wang CJ, Lu H, Lee K, Lee LH, Lee WC et al (2005) Deep-vein thrombosis rates after major orthopedic surgery in Asia. An epidemiological study based on postoperative screening with centrally adjudicated bilateral venography. J Thromb Haemost 3(12):2664–2670. https://doi.org/10.1111/j.1538-7836.2005.01621.x

Kim KI, Cho KY, Jin W, Khurana SS, Bae DK (2011) Recent Korean perspective of deep vein thrombosis after total knee arthroplasty. J Arthroplast 26(7):1112–1116. https://doi.org/10.1016/j.arth.2011.02.021

Harrison-Brown M, Scholes C, Douglas SL, Farah SB, Kerr D, Kohan L (2020) Multimodal thromboprophylaxis in low-risk patients undergoing lower limb arthroplasty: a retrospective observational cohort analysis of 1400 patients with ultrasound screening. J Orthop Surg (Hong Kong) 28(2):2309499020926790

Lee WS, Kim KI, Lee HJ, Kyung HS, Seo SS (2013) The incidence of pulmonary embolism and deep vein thrombosis after knee arthroplasty in Asians remains low: a meta-analysis. Clin Orthop Relat Res 471(5):1523–1532. https://doi.org/10.1007/s11999-012-2758-9

Park SH, Ahn JH, Park YB, Lee SG, Yim SJ (2016) Incidences of deep vein thrombosis and pulmonary embolism after total knee arthroplasty using a mechanical compression device with and without low-molecular-weight heparin. Knee Surg Relat Res 28(3):213–218. https://doi.org/10.5792/ksrr.2016.28.3.213

Chung KS, Shin TY, Park SH, Kim H, Choi CH (2018) Rivaroxaban and acetylsalicylic acid for prevention of venous thromboembolism following total knee arthroplasty in Korean patients. Knee Surg Relat Res. 30(3):247–254. https://doi.org/10.5792/ksrr.17.092

Masuda EM, Kistner RL, Musikasinthorn C, Liquido F, Geling O, He Q (2012) The controversy of managing calf vein thrombosis. J Vasc Surg 55(2):550–561. https://doi.org/10.1016/j.jvs.2011.05.092

Sasaki H, Ishida K, Shibanuma N, Tei K, Tateishi H, Toda A, Yamashiro Y, Matsumoto T, Kuroda R, Kurosaka M (2014) Retrospective comparison of three thromboprophylaxis agents, edoxaban, fondaparinux, and enoxaparin, for preventing venous thromboembolism in total knee arthroplasty. Int Orthop 38(3):525–529. https://doi.org/10.1007/s00264-013-2132-x

Beyer-Westendorf J, Lutzner J, Donath L, Radke OC, Kuhlisch E, Hartmann A et al (2012) Efficacy and safety of rivaroxaban or fondaparinux thromboprophylaxis in major orthopedic surgery: findings from the ORTHO-TEP registry. J Thromb Haemost 10(10):2045–2052. https://doi.org/10.1111/j.1538-7836.2012.04877.x

Fuji T, Wang CJ, Fujita S, Kawai Y, Nakamura M, Kimura T, Ibusuki K, Ushida H, Abe K, Tachibana S (2014) Safety and efficacy of edoxaban, an oral factor Xa inhibitor, versus enoxaparin for thromboprophylaxis after total knee arthroplasty: the STARS E-3 trial. Thromb Res 134(6):1198–1204. https://doi.org/10.1016/j.thromres.2014.09.011

Kim YH, Anil V, Gaurav A, Park JW, Kim JS (2019) Mechanical thromboprophylaxis would suffice after total knee arthroplasties in Asian patients? Arch Orthop Trauma Surg 139(2):167–171. https://doi.org/10.1007/s00402-018-3045-3

Cho KY, Kim KI, Khurana S, Bae DK, Jin W (2013) Is routine chemoprophylaxis necessary for prevention of venous thromboembolism following knee arthroplasty in a low incidence population? Arch Orthop Trauma Surg 133(4):551–559. https://doi.org/10.1007/s00402-013-1691-z

Clarke MT, Green JS, Harper WM, Gregg PJ (1997) Screening for deep-venous thrombosis after hip and knee replacement without prophylaxis. J Bone Joint Surg Br 79(5):787–791. https://doi.org/10.1302/0301-620X.79B5.0790787

Kim YH (1990) The incidence of deep vein thrombosis after cementless and cemented knee replacement. J Bone Joint Surg Br. 72(5):779–783

Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, Ray JG (2004) Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 126(3 Suppl):338S–400S. https://doi.org/10.1378/chest.126.3_suppl.338S

McKenna R, Bachmann F, Kaushal SP, Galante JO (1976) Thromboembolic disease in patients undergoing total knee replacement. J Bone Joint Surg Am 58(7):928–932. https://doi.org/10.2106/00004623-197658070-00006

Lotke PA, Steinberg ME, Ecker ML (1994) Significance of deep venous thrombosis in the lower extremity after total joint arthroplasty. Clin Orthop Relat Res 299:25–30

White RH, Keenan CR (2009) Effects of race and ethnicity on the incidence of venous thromboembolism. Thromb Res 123(Suppl 4):S11–S17. https://doi.org/10.1016/S0049-3848(09)70136-7

Kim YH, Yoo JH, Kim JS (2007) Factors leading to decreased rates of deep vein thrombosis and pulmonary embolism after total knee arthroplasty. J Arthroplast 22(7):974–980. https://doi.org/10.1016/j.arth.2007.03.033

Kim YH, Oh SH, Kim JS (2003) Incidence and natural history of deep-vein thrombosis after total hip arthroplasty. A prospective and randomised clinical study. J Bone Joint Surg Br. 85(5):661–665

Zhang S, Htet KS, Tan XY, Wang X, Wang W, Chua W (2020) Short-duration chemoprophylaxis might reduce incidence of deep vein thrombosis in Asian patients undergoing total knee arthroplasty. Knee Surg Relat Res. 32(1):58. https://doi.org/10.1186/s43019-020-00077-w

Park KH, Cheon SH, Lee JH, Kyung HS (2012) Incidence of venous thromboembolism using 64 channel multidetector row computed tomography-indirect venography and anti-coagulation therapy after total knee arthroplasty in Korea. Knee Surg Relat Res. 24(1):19–24. https://doi.org/10.5792/ksrr.2012.24.1.19

Leizorovicz A, Committee SVSS (2007) Epidemiology of post-operative venous thromboembolism in Asian patients. Results of the SMART venography study. Haematologica. 92(9):1194–1200. https://doi.org/10.3324/haematol.10819

Tateiwa T, Ishida T, Masaoka T, Shishido T, Takahashi Y, Onozuka A et al (2019) Clinical course of asymptomatic deep vein thrombosis after total knee arthroplasty in Japanese patients. J Orthop Surg (Hong Kong) 27(2):2309499019848095

Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, Ortel TL, Pauker SG, Colwell CW Jr (2012) Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 141(2 Suppl):e278S–e325S. https://doi.org/10.1378/chest.11-2404

Melese KG, Weji BG, Berheto TM, Bekru ET (2020) Utilization of partograph during labour: a case of Wolaita Zone, Southern Ethiopia. Heliyon 6(12):e05633. https://doi.org/10.1016/j.heliyon.2020.e05633

Osiewicz M, Lobbezoo F, Ciapala B, Pytko-Polonczyk J, Manfredini D (2020) Pain predictors in a population of temporomandibular disorders patients. J Clin Med 9(2):452

Takigawa T, Tanaka M, Sugimoto Y, Tetsunaga T, Nishida K, Ozaki T (2017) Discrimination between malignant and benign vertebral fractures using magnetic resonance imaging. Asian Spine J 11(3):478–483. https://doi.org/10.4184/asj.2017.11.3.478

Barrack RL (2012) Current guidelines for total joint VTE prophylaxis: dawn of a new day. J Bone Joint Surg Br 94(11 Suppl A):3–7

Sun G, Wu J, Wang Q, Liang Q, Jia J, Cheng K, Sun G, Wang Z (2019) Factor Xa inhibitors and direct thrombin inhibitors versus low-molecular-weight heparin for thromboprophylaxis after total hip or total knee arthroplasty: a systematic review and meta-analysis. J Arthroplast 34(4):789–800 e6. https://doi.org/10.1016/j.arth.2018.11.029

Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, Sage D, Futter M, Saville G, Clark T, MacMahon S (2000) Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 321(7275):1493. https://doi.org/10.1136/bmj.321.7275.1493

Jiang T, Song K, Yao Y, Pan P, Jiang Q (2019) Perioperative allogenic blood transfusion increases the incidence of postoperative deep vein thrombosis in total knee and hip arthroplasty. J Orthop Surg Res 14(1):235. https://doi.org/10.1186/s13018-019-1270-2

Hu S, Zhang ZY, Hua YQ, Li J, Cai ZD (2009) A comparison of regional and general anaesthesia for total replacement of the hip or knee: a meta-analysis. J Bone Joint Surg Br. 91(7):935–942

Pugely AJ, Martin CT, Gao Y, Mendoza-Lattes S, Callaghan JJ (2013) Differences in short-term complications between spinal and general anesthesia for primary total knee arthroplasty. J Bone Joint Surg Am 95(3):193–199. https://doi.org/10.2106/JBJS.K.01682

Ishii Y, Noguchi H, Sato J, Takayama S, Okada Y, Toyabe SI (2018) Impact of anesthesia modality and mechanical venous thromboembolism prophylaxis on the incidence of symptomatic deep venous thrombosis after TKA. J Clin Orthop Trauma 9(2):142–145. https://doi.org/10.1016/j.jcot.2016.10.013

Fu D, Li G, Chen K, Zeng H, Zhang X, Cai Z (2013) Comparison of clinical outcome between simultaneous-bilateral and staged-bilateral total knee arthroplasty: a systematic review of retrospective studies. J Arthroplast 28(7):1141–1147. https://doi.org/10.1016/j.arth.2012.09.023

Liu L, Liu H, Zhang H, Song J, Zhang L (2019) Bilateral total knee arthroplasty: simultaneous or staged? A systematic review and meta-analysis. Medicine (Baltimore) 98(22):e15931. https://doi.org/10.1097/MD.0000000000015931

Yoo MC, Cho YJ, Ghanem E, Ramteke A, Kim KI (2009) Deep vein thrombosis after total hip arthroplasty in Korean patients and D-dimer as a screening tool. Arch Orthop Trauma Surg 129(7):887–894. https://doi.org/10.1007/s00402-008-0751-2

Tan M, van Rooden CJ, Westerbeek RE, Huisman MV (2009) Diagnostic management of clinically suspected acute deep vein thrombosis. Br J Haematol 146(4):347–360. https://doi.org/10.1111/j.1365-2141.2009.07732.x

Chang MJ, Song MK, Kyung MG, Shin JH, Chang CB, Kang SB (2018) Incidence of deep vein thrombosis before and after total knee arthroplasty without pharmacologic prophylaxis: a 128-row multidetector CT indirect venography study. BMC Musculoskelet Disord 19(1):274. https://doi.org/10.1186/s12891-018-2166-8

Shin WC, Woo SH, Lee SJ, Lee JS, Kim C, Suh KT (2016) Preoperative prevalence of and risk factors for venous thromboembolism in patients with a hip fracture: an indirect multidetector CT venography study. J Bone Joint Surg Am 98(24):2089–2095. https://doi.org/10.2106/JBJS.15.01329

Thông tin
Thông tin xuất bản

Knee Surgery & Related Research

Thông tin tác giả