Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: Part 1. Diagnosis and risk factors

Ngarmukos, Srihatach; Kim, Kang‐Il; Wongsak, Siwadol; Chotanaphuti, Thanainit; Inaba, Yutaka; Chen, Cheng Fong; Liu, David

doi:10.1186/s43019-021-00099-y

Cited by 19 publications

(32 citation statements)

References 96 publications

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“…Therefore, pharmacological VTE prophylaxis with warfarin, low molecular weight heparin (LMWH), factor Xa inhibitors (fondaparinux, apixaban, dabigatran, rivaroxaban), or aspirin has been suggested in several guidelines 1 , 2 . Because of the lower rates of VTE in Asian population 3 – 5 , pharmacological VTE prophylaxis would be administered for Asian patients undergoing TJA procedures based on VTE and bleeding risk 6 , 7 . For patients who had history of VTE, varicose veins, congestive heart failure, thromboembolic stroke, family history of VTE, underwent a simultaneous bilateral TJA procedure or a prolonged procedure (> 2 h), the VTE risk was considered elevated 6 .…”

Section: Introductionmentioning

confidence: 99%

“…Because of the lower rates of VTE in Asian population 3 – 5 , pharmacological VTE prophylaxis would be administered for Asian patients undergoing TJA procedures based on VTE and bleeding risk 6 , 7 . For patients who had history of VTE, varicose veins, congestive heart failure, thromboembolic stroke, family history of VTE, underwent a simultaneous bilateral TJA procedure or a prolonged procedure (> 2 h), the VTE risk was considered elevated 6 . Factors associated with increased bleeding risk included advanced age, active cancer with or without metastasis, liver or renal failure, thrombocytopenia, hemophilia and other bleeding disorders 6 .…”

Section: Introductionmentioning

confidence: 99%

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Pharmacological thromboprophylaxis as a risk factor for early periprosthetic joint infection following primary total joint arthroplasty

Pai

Chang

Tsai

et al. 2022

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Venous thromboembolism (VTE) prophylaxis has been suggested for patients who underwent total join arthroplasty (TJA). However, the morbidity of surgical site complications (SSC) and periprosthetic joint infection (PJI) has not been well evaluated. We aimed to evaluate the impact of VTE prophylaxis on the risk of early postoperative SSC and PJI in a Taiwanese population. We retrospectively reviewed 7511 patients who underwent primary TJA performed by a single surgeon from 2010 through 2019. We evaluated the rates of SSC and PJI in the early postoperative period (30-day, 90-day) as well as 1-year reoperations. Multivariate regression analysis was used to identify possible risk factors associated with SSC and PJI, including age, sex, WHO classification of weight status, smoking, diabetes mellitus (DM), rheumatoid arthritis(RA), Charlson comorbidity index (CCI), history of VTE, presence of varicose veins, total knee or hip arthroplasty procedure, unilateral or bilateral procedure, or receiving VTE prophylaxis or blood transfusion. The overall 90-day rates of SSC and PJI were 1.1% (N = 80) and 0.2% (N = 16). VTE prophylaxis was a risk factor for 90-day readmission for SSC (aOR: 1.753, 95% CI 1.081–2.842), 90-day readmission for PJI (aOR: 3.267, 95% CI 1.026–10.402) and all 90-day PJI events (aOR: 3.222, 95% CI 1.200–8.656). Other risk factors included DM, underweight, obesity, bilateral TJA procedure, younger age, male sex and RA. Pharmacological thromboprophylaxis appears to be a modifiable risk factor for SSC and PJI in the early postoperative period. The increased infection risk should be carefully weighed in patients who received pharmacological VTE prophylaxis.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pharmacological thromboprophylaxis as a risk factor for early periprosthetic joint infection following primary total joint arthroplasty

Pai

Chang

Tsai

et al. 2022

Sci Rep

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“…Regional variability may also play a role in VTE rate differences. Several reports suggest lower VTE rates in Asian patients, both in THA and TKA 75-78,86-91 . Lee et al, performed a meta-analysis of the incidence of VTE in Asian patients undergoing TKA who did not use thromboprophylaxis 89 .…”

Section: - Is There a Difference In Vte Risk Profile For Patients Und...mentioning

confidence: 99%

“…Seven studies reported symptomatic DVT, which was 1.9%. As such, the Asia-Pacific Venous Thromboembolism Consensus has agreed that the risk of VTE is lower in patients of Asian ethnicity 90 . These results differ markedly from those coming from other parts of the world.…”

Section: - Is There a Difference In Vte Risk Profile For Patients Und...mentioning

confidence: 99%

Recommendations from the ICM-VTE: Hip & Knee

2022

Journal of Bone and Joint Surgery

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The ICM-VTE Hip & Knee Delegates* 1 -Is VTE after elective total joint arthroplasty a "never event"?Response/Recommendation: Venous thromboembolism (VTE) after elective total joint arthroplasty (TJA) continues to occur despite various strategies in prophylaxis and should not be considered a "never event."Strength of Recommendation: Moderate.Delegates vote: Agree 94.87% Disagree 5.13% Abstain 0.00% (Strong Consensus).Rationale: As part of an initiative to address quality of care and control healthcare costs, in 2002, the United States Centers for Medicare and Medicaid Services (CMS) defined "never events" as hospital-acquired conditions that were considered reasonably preventable 1 . In 2008, CMS added deep venous thrombosis (DVT) and pulmonary embolism (PE) following total knee arthroplasty (TKA) and total hip arthroplasty (THA) 2 .Historically, DVT and PE were important risks for patients undergoing TJA. In a study of 7,959 patients between 1962 and 1973, Charnley et al., reported a non-fatal PE rate of 7.89% and a 1.04% rate of fatal PE which constituted the highest single cause of death after a THA 3 . Coventry et al., identified a cohort of 2012 THA from 1969 to 1971 of which 58 did not receive chemoprophylaxis past post-operative day five and observed a DVT rate of 3.4%, a non-fatal PE rate of 5.2%, and a fatal PE rate of 3.4% 4,5 . In a series performed between 1990 and 1991, Warwick et al., identified 1,162 patients undergoing THA without routine chemoprophylaxis, with DVT confirmed by venography in 1.89% of patients and a PE rate of 1.20% with a subsequent mortality rate of 0.34% 6 .Early studies demonstrated a much higher incidence of VTE for TKA 7,8 . However, DVT in TKA patients occur distally in the calf which are less likely to progress into a PE which was observed at a rate of 1.3% 9 with fatalities of 0.19 to 0.4% 9,10 . Stulburg et al., examined a series of 638 patients from 1974 to 1979 among which 49 patients inadvertently did not receive prophylaxis; an impressive 83% of these patients developed a DVT 11 .In a prospective study with 34,397 consecutive and unselected THA or TKA procedures, 32 (0.09%) had a VTE after median two days despite ongoing thromboprophylaxis 12 . All surgery was done in a fast-track setup with accelerated mobilization and discharge. Another study has shown a 90-day incidence of 0.41% of VTE after unicompartmental knee arthroplasty 13 . All patients received thromboprophylaxis until discharge and were operated in a fast-track setup with a median length of stay of one day.With VTE as a common and potentially dangerous complication after TKA and THA, safe and effective strategies for prophylaxis were developed and studied. When warfarin dosage is titrated to an international normalized ratio (INR) of 1.5 to 2.0 and administered for approximately six weeks, DVT occurred at a rate of 0.2 to 1% with a non-fatal PE rate of 0.1 to 0.3% [14][15][16] . Warfarin was found to consistently decreased rates of VTE when utilized after THA or TKA, but may lead to a significant risk ...

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“…Several meta-analyses confirmed that IV administration of TXA reduces postoperative bleeding and need for transfusion [ 3 , 4 ]. Though there has not been obvious evidence of thromboembolic complications after systemic use of TXA [ 8 – 10 , 37 , 38 ], topical application of TXA has been introduced to reduce this complication [ 11 , 12 ]. Several studies reported that IV and topical injection of TXA showed similar effectiveness in reducing blood loss and transfusion following TKA [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Tranexamic acid in a periarticular multimodal cocktail injection for blood management in total knee arthroplasty: a prospective randomized study

Kim

Bae

Kim

et al. 2021

BMC Musculoskelet Disord

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Background This study aimed to assess the efficacy of tranexamic acid (TXA) mixed in a periarticular multimodal cocktail (PAMC) as a topical administration and to determine whether combined use of intravenous and topical administration is more effective than a single administration of TXA. Methods A total of 240 patients who underwent primary total knee arthroplasty (TKA) was enrolled for this prospective randomized controlled study. Patients were divided into three groups of 80 patients each. Baseline data were comparable for all groups. Average follow-up was 18.7 months. Group 1 consisted of patients who received intravenous (IV) TXA, Group 2 patients were those who received TXA in a PAMC injection for topical administration, and Group 3 consisted of patients who received a combination of both intravenous and topical administration of TXA. Primary outcomes were postoperative hemoglobin drop and amount of suction drainage. Secondary outcomes were estimated blood loss (EBL), postoperative transfusion rate, and complications. Results The mean postoperative hemoglobin drop was significantly lower in Group 3 (2.13 ± 0.77 g/dL, p=0.004), and there was no difference between Group 1 and Group 2 (2.56 ± 1.07 g/dL vs 2.55 ± 0.86 g/dL, p=0.999). The mean drainage amount was significantly lower in Group 3 (326.58 ± 57.55 ml, p<0.001), and there was no difference between Group 1 and Group 2 (367.93 ± 87.26 ml vs 397.66 ± 104.10 ml, p=0.072). Similarly, the mean EBL was significantly lower in Group 3 (p=0.003), and there was no significant difference between Group 1 and Group 2 (p=0.992). There were no significant differences in requirement for postoperative transfusion rate or incidence of complications among the three groups. Conclusion TXA mixed in a PAMC injection showed a similar effect to IV administration of TXA following TKA. Furthermore, combined use of both IV and PAMC injection provided better perioperative bleeding control with similar safety in patients without relevant comorbidities. Trial registration WHO ICTRP identifier KCT0005703. Retrospectively registered: 12/24/2020

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Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: Part 1. Diagnosis and risk factors

Cited by 19 publications

References 96 publications

Pharmacological thromboprophylaxis as a risk factor for early periprosthetic joint infection following primary total joint arthroplasty

Pharmacological thromboprophylaxis as a risk factor for early periprosthetic joint infection following primary total joint arthroplasty

Recommendations from the ICM-VTE: Hip & Knee

Tranexamic acid in a periarticular multimodal cocktail injection for blood management in total knee arthroplasty: a prospective randomized study

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