A single‐centre prospective study of clinical and haemostatic risk factors for venous thromboembolism following lower limb arthroplasty

Abstract

Summary Previous studies report conflicting results concerning the potential significance of thrombophilic genotypes in postarthroplasty venous thromboembolism (VTE). This study assessed thrombophilic genotypes, haemostatic and clinical variables as independent risk factors for VTE postarthroplasty. A total number of 569 patients undergoing elective lower limb arthroplasty at a single centre were prospectively studied. All patients were interviewed and had blood samples collected preoperatively. Bilateral lower limb ultrasonography was performed at day 7 ± 2 postoperatively in all patients (ventilation/perfusion lung scanning in symptomatic patients only). The incidence of inhospital postoperative VTE was 26%. In univariate analysis – increased age, knee arthroplasty, recent surgery, general anaesthesia, shorter operation time, non‐receipt of blood transfusion and differences in surgical practice (including use of pneumatic calf compression, surgical drains and postoperative bandaging techniques) were significantly associated with VTE. Factor V Leiden, prothrombin G20210A and MTHFR C677T mutations were not significant risk factors for VTE, and of all haemostatic variables tested, only median activated partial thromboplastin time showed significant difference between VTE and non‐VTE patients (34 s vs. 33 s). Multiple logistic regression analysis demonstrated that increased age, knee arthroplasty and individual surgeon's routine practices were the only significant independent risks for VTE; hence routine preoperative blood screening for a potential hypercoaguable state is not indicated in this surgical setting.

Genetic Polymorphisms in Venous Thrombosis and Pulmonary Embolism After Total Hip Arthroplasty: A Pilot Study

“…The residual risk for venographically diagnosed DVT after THA remains within a range of 9% to 36% [17,18,21,29]. This risk is even higher after TKA, with risks of as much as 52% [18]. Less than 10% of all DVT, however, may become symptomatic [18].…”

“…This risk is even higher after TKA, with risks of as much as 52% [18]. Less than 10% of all DVT, however, may become symptomatic [18]. Furthermore, the type of DVT varies after these different orthopaedic procedures with a higher rate of distal DVT (89% versus 60%) and a lower rate of proximal DVT (9% versus 37%) after TKA compared with THA [18].…”

“…For other genetic markers, such an association is suspected and discussed controversially, eg, methylenetetrahydrofolate reductase (MTHFR) C677T and/or A1298C and plasminogen activator inhibitor 1 (PAI-1) 4G/5G polymorphisms [1-3, 10, 11, 16, 22, 30, 32, 34, 37, 44]. Results of former studies are conflicting regarding whether the single or combined presence of such genetic mutations may further increase the already very high risk for DVT after major orthopaedic surgery, justifying costly preoperative screening and additional antithrombotic prophylactic measures in these patients [5,6,8,18,20,21,23,29,31,36,[40][41][42][43]. One reason for the conflicting results may be found in the different clinical end points set in the studies varying among venographically diagnosed DVT, clinically symptomatic DVT with or without PE, or symptomatic PE only.…”

“…Despite routinely performed prophylactic chemical and mechanical measures during the perioperative period, a considerable number of patients still experience DVT after major orthopaedic surgery [18,21,29]. The residual risk for venographically diagnosed DVT after THA remains within a range of 9% to 36% [17,18,21,29].…”

“…Less than 10% of all DVT, however, may become symptomatic [18]. Furthermore, the type of DVT varies after these different orthopaedic procedures with a higher rate of distal DVT (89% versus 60%) and a lower rate of proximal DVT (9% versus 37%) after TKA compared with THA [18]. This probably is related to local tissue trauma at the site of surgery, manipulation of the knee during surgery, and the use of a tourniquet with subsequent distal venous stasis [18].…”