Association between metabolic syndrome and venous thromboembolism after total joint arthroplasty: a meta-analysis of cohort studies

Abstract

Objective Metabolic syndrome (MetS) has been associated with hypercoagulative status. However, previous studies evaluating the association between MetS and incidence of venous thromboembolism (VTE) after total joint arthroplasty (TJA) showed inconsistent results. We performed a meta-analysis to evaluate the influence of MetS on the risk of VTE following TJA. Methods Cohort studies were identified by the search of PubMed, Embase, and the Cochrane’s Library databases. A random-effect model was used if considerable heterogeneity was detected; otherwise, a fixed-effect model was used. Subgroup analyses according to the category of VTE, definition of MetS, category of procedure, and follow-up durations were performed. Results Seven cohort studies with 1,341,457 patients that underwent TJA were included, with 118,060 MetS patients (8.8%) at baseline. With a follow-up duration up to 3 months after surgery, 9788 patients had VTE. Pooled results with a random-effect model showed that MetS was not associated with increased overall VTE after TJA (adjusted risk ratio [RR] = 1.24, 95% confidence interval [CI] 0.89 ~ 1.72, p = 0.20; I2 = 69%). The results were not significantly affected by the diagnostic criteria of MetS, category of the procedure, and follow-up durations. Subgroup analyses showed that MetS was not associated with an increased the risk of pulmonary embolism ([PE], RR 1.06, 95% CI 0.37 ~ 3.02, p = 0.91), but an increased risk of deep vein thrombosis (DVT) after TJA (RR 3.38, 95% CI 1.83 ~ 6.24, p < 0.001). Conclusions Current evidence from observational studies suggests MetS might be associated with an increased risk of DVT but not PE after TJA.

Prediction of the Risk of Preoperative Deep Vein Thrombosis in Non-fractured Patients Awaiting Total Joint Arthroplasty Using a Support Vector Machine

“…Previous literature has con rmed that a history of hypertension can increase the risk of VTE after orthopedic surgery [34][35][36]. A metaanalysis of 16 studies involving orthopedic surgical patients (68955 males and 53057 females) reported a signi cant association between hypertension and postoperative DVT (OR = 2.89, 95%CI = 2.18-3.83, P < 0.05, Z = 7.38) [37]. The results of this study suggest that the prevalence of DVT is also signi cantly higher in patients with hypertension prior to joint arthroplasty, and the presumed cause is related to the fact that patients with hypertension are more likely to have disorders of the coagulation system, vascular in ammation, and endothelial dysfunction.…”

Basic science research opportunities in thrombosis and hemostasis: Communication from the SSC of the ISTH

“…Importantly, cancer is a major cause of death in VTE patients and vice versa. Obesity is associated with a 2‐ to 5‐fold increase in VTE compared to individuals within the normal body mass index range, 59‐61 and similar significant increases in VTE are noted in metabolic syndrome 62‐65 and diabetic patients 66,67 . The relationship between VTE and pathogenic infections has been an area of interest for some years but has jostled to the forefront by way of the COVID‐19 pandemic 68‐71 .…”