Deep vein thrombosis after total hip and knee arthroplasty in Indian patients

Abstract

Background: Deep vein thrombosis (DVT) is one of the most common complications of total hip (THA) and total knee arthroplasty (TKA). Though the reported incidence of DVT is very high, that of proximal DVT is low and that of fatal thromboembolism is very low. Hence the issue of prophylaxis for DVT remains controversial.The incidence of DVT is based on various studies in European and American populations. The Asian population is genetically and socially quite different from American and European populations, and the incidence of DVT can be quite different. Therefore a prospective study was initiated at our centre to determine incidence of DVT after THA and TKA in Indian patients. Methods: A prospective study was conducted on 60 hips in 45 patients and 46 knees in 26 patients who underwent THA and TKA respectively, without any known risk factors for thromboembolic disease. DVT was studied by preoperative and postoperative serial colour Doppler ultrasonography. No prophylaxis was given to any of the patients. Results: DVT was found in two patients who had undergone THA. No case of DVT was detected in any patient who had undergone TKA. Conclusion: These results suggest that the incidence of DVT in Indian patients is very low and is not comparable with American and European populations. It is therefore not cost effective to advise prophylaxis in Indian patients undergoing THA/TKA who have no known risk factors for DVT.

Is pre-operative assessment of coagulation profile with Thrombelastography (TEG) useful in predicting venous thromboembolism (VTE) following orthopaedic surgery?

“…4 Jain et al reported only 2 episodes of DVT in 71 patients (106 major surgeries of the hip and knee) who did not have anticoagulant prophylaxis peri-operatively. 3 Goyal et al…”

“…2,[5][6][7] In India, there are conflicting reports on the incidence of VTE. [1][2][3][4] While Bagaria 4 and Jain et al 3 reported a low incidence of DVT, Agarwala et al 2 and Dhillon 5 showed an incidence of around 60% in patients who did not have prophylaxis peri-operatively. In view of the conflicting data available, we found it necessary to have a prospective study on the incidence of VTE in high-risk orthopaedic surgery patients who were not on chemoprophylaxis at our institution.…”

“…[1][2][3][4][5][6][7][8][9] While many studies have shown that the incidence of deep vein thrombosis (DVT) is lower in Asian patients than the Western population, 1,3,4,9 some of the recent studies from China and south east Asia have shown significant incidence of DVT in high-risk orthopaedic patients. 2,[5][6][7] In India, there are conflicting reports on the incidence of VTE.…”

The prevalence of deep vein thrombosis in a cohort of patients with spinal cord injury following the Pakistan earthquake of October 2005

“…3,5,[15][16][17] Studies in Pakistan to asses the frequency of DVT in high-risk surgical patients without thromboprophylaxis revealed an incidence ranging from 0 to 12.8%. 6,18,19 Similarly, studies conducted in neighboring India to asses the risk of DVT in patients undergoing hip and knee arthroplasties reported the incidence of DVT to be 6.1% (Bagaria et al 4 ) and 2.8% ( Jain et al 20 ), respectively, which is significantly lower than the incidence in the West. 8,9 In our study, DVT was found to be more common in patients who had complete SCI and were immobilized for a longer period of time than the patients having incomplete injury or no neurological deficit and who were mobilized earlier.…”

Is it necessary to use chemoprophylaxis in Indian patients after hip surgery?

“…This incidence is more than the reported incidence in various studies by Froehlich et al 14 (12%), Nagi et al 8 (8%) and Mavalankar et al 12 (7.2%) and lower than Bhan et al 10 (23.33%), Sharma et al 9 (19.6%) and Agarwala et al 13 (60%). Jain et al 15 reported a very low incidence of DVT following TKA and THA in Indian patients. Agarwala et al reported 60% incidence of DVT in Indian patients without chemo-prophylaxis and 43.2% with prophylaxis following major lower limb surgery by using contrast venography.…”