Nationwide study on the risk of unprovoked venous thromboembolism in non-traumatic osteonecrosis of femoral head

Sung, Pei‐Hsun; Chiang, Hsin‐Ju; Yang, Ya‐Chen; Chiang, John Y.; Yip, Hon‐Kan; Lee, Mel S.

doi:10.1007/s00264-018-3866-2

Cited by 11 publications

(13 citation statements)

References 38 publications

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“…In the previous study, the incidences of unprovoked VTE, DVT, and PE were 1.2%, 1.0%, and 0.2%, respectively [20]. Current study found the corresponding incidences were slightly increased to 1.4%, 1.1%, and 0.4%, respectively.…”

Section: Discussionmentioning

confidence: 54%

“…Short-term or long-term administration of NSAID protected ONFH patients from postoperative VTE was noted in the present study. Also, data from the previous two studies [14,20] have documented that NSAID has the protective effects against not only provoked VTE but also MACCE in patients with nontraumatic ONFH. Although most early researches have shown the use of non-selective NSAID strongly leads to endothelial dysfunction and links to arterial/venous thrombotic complications [27,28], yet more and more recent meta-analyses have challenged the cardiovascular safety issue of NSAID, especially cyclooxygenase-2 (COX-2) selective inhibitor [29,30].…”

Section: Discussionmentioning

confidence: 96%

“…Two previous clinical observational researches to investigate the association between ONFH and cardiovascular diseases [14,20] have shown positive results that both major adverse cardiovascular or cerebrovascular events (MACCE) and VTE were significantly increased in the ONFH population as compared with the general population. The underlying mechanism is thought to be related to the endothelial dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…In the former study [14], the ONFH patients were found to have about twice increased risk for MACCE even after multivariate adjustment for medications, surgery and relevant comorbidities. The latter study was aimed to find the incidence of unprovoked VTE in non-traumatic ONFH [20]. Those subjects with precedent trauma, underwent LLS in one year, and occurrence of VTE within one year after surgery were excluded, due to an obviously increased VTE risk through blood stasis and vascular/endothelial injury, the two crucial components of Virchow's triad [23].…”

Section: Discussionmentioning

confidence: 99%

“…In a study comparing 20 ONFH patients with age-, gender-, income-and urbanization-matched population, the incidence and risk of unprovoked VTE are significantly higher in ONFH patients. However, subjects who had LLS within one year since enrollment or diagnosed with VTE within one year after surgery were excluded in that study [20]. Thus, the risk of postoperative VTE in patients with ONFH undergoing hip replacement surgery remains regrettably unanswered.…”

Section: Introductionmentioning

confidence: 99%

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Risk of Venous Thromboembolic Events in Patients with Osteonecrosis of the Femoral Head Undergoing Primary Hip Arthroplasty

Sung

Yang

Chiang

et al. 2019

JCM

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Previous data have shown patients with osteonecrosis of the femoral head (ONFH) have increased lifelong risk of unprovoked venous thromboembolic events (VTE) as compared with the general population, according to sharing common pathological mechanism of endothelial dysfunction. However, whether the risk of VTE increases in those ONFH patients undergoing major hip replacement surgery remains unclear. This is a retrospective nationwide Asian population-based study. From 1997 to 2013, a total of 12,232 ONFH patients receiving partial or total hip replacement for the first time and revision surgeries were retrospectively selected from Taiwan Health Insurance surgical files. By 1:1 matching on age, sex, surgical types, and socioeconomic status, 12,232 subjects without ONFH undergoing similar hip surgery were selected as non-ONFH group. The incidence and risk of post-surgery VTE, including deep venous thrombosis (DVT) and pulmonary embolism (PE), were compared between the ONFH and non-ONFH groups. Results showed that 53.8% of ONFH patients were male and the median age was 61.9 years old. During the mean follow-up period of 6.4 years, the incidences of VTE (1.4% vs. 1.2%), DVT (1.1% vs. 0.9%), and PE (0.4% vs. 0.4%) were slightly but insignificantly higher in the ONFH than in the non-ONFH group undergoing the same types of major hip replacement surgery (all p-values > 0.250). Concordantly, we found no evidence that the risk of VTE was increased in the ONFH patients as compared with the non-ONFH counterparts (adjusted HR 1.14; 95% CI 0.91–1.42; p = 0.262). There were also no increased risks for DVT and PE in the ONFH subgroups stratified by comorbidities, drug exposure to pain-killer or steroid, and follow-up duration after surgery, either. In conclusion, hip arthroplasty in Asian patients with ONFH is associated with similar rates of VTE as compared to patients with non-ONFH diagnoses.

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Section: Discussionmentioning

confidence: 54%