Deep vein thrombosis in arthroscopic surgery and chemoprophylaxis recommendation in an Asian population

Abstract

INTRODUCTIONThere are currently no guidelines supporting the use of routine chemoprophylaxis to prevent deep vein thrombosis (DVT) in arthroscopic surgery. Studies and meta-analysis show opposing views on its routine use in arthroscopy. This study aimed to examine the incidence of DVT in a prospective cohort of knee arthroscopy and knee arthroplasty patients, and to analyse the risk factors contributing to DVT. METHODSAll patients scheduled to undergo knee arthroscopy or arthroplasty over a two-year period were included.A standardised regimen of postoperative mechanical prophylaxis and rehabilitation was applied to all patients. Only patients who were postoperatively symptomatic were referred for ultrasonography. DVT incidence was calculated, and univariate and multivariate analyses of the risk factors were performed. RESULTSThe overall incidence of DVT was 0.5% among the 1,410 arthroscopy patients and 3.1% among the 802 arthroplasty patients. The incidence of proximal DVT among the arthroscopy and arthroplasty patients was 0.4% and 1.1%, respectively. Multivariate analysis showed that age was the only signifi cant predictor of DVT incidence. Using the receiver operating characteristic method, the cut-off age for the arthroscopy and arthroplasty patients was 52 years, while that for the arthroscopy patients only was 40 years (increased risk of DVT: 5.46 and 6.44 times, respectively; negative predictive value: 99.7% and 99.8%, respectively).CONCLUSION DVT incidence among Asian arthroplasty and arthroscopy patients remains low, even without chemoprophylaxis. Since age was found to be a signifi cant risk factor for DVT, DVT prophylaxis can be considered for patients in high-risk age groups.

Symptomatic Deep Vein Thrombosis Following Elective Knee Arthroscopy Over the Age of 40

“…[7][8][9][10][11][12][13] The rate of symptomatic proximal thrombosis is reported much less (0.25%-0.67%). 1,3,10,14 However, VTE accounts for 7% to 30% of all complications following AKS. 15,16 Although some authors recommend routine prophylaxis after AKS, routine prophylaxis is not recommended in the guidelines.…”

Low molecular weight heparin versus other anti-thrombotic agents for prevention of venous thromboembolic events after total hip or total knee replacement surgery: a systematic review and meta-analysis

“…These procedures can also result in deep venous thrombosis (DVT), pulmonary embolism (PE), infection, and death [ 3 ]. Asian patients aged ≥40 years had a significantly higher relative risk of developing DVT, proximal DVT and PE [ 4 ].…”

“…Anticoagulants are routinely used and recommended after major orthopedic surgery to prevent VTE Anticoagulants has been found to reduce the risk of thromboembolic events by approximately 50% to 80% when prescribed prophylactically [ 1 ]. Both the American College of Chest Physicians (ACCP) and American Association of Orthopedic Surgeons (AAOS) guidelines for VTE prophylaxis recommend antithrombotic prophylaxis following THR or TKR [ 2 , 4 ]. However, although pharmacologic thromboprophylaxis in patients with THR or TKR may decrease the incidence of VTE and other thrombus related events, it can cause increased risk of major bleeding [ 2 , 5 ].…”

Deep vein thrombosis following arthroscopic meniscal root repair: A case report

“…There are three studies to date which have evaluated the risk of DVT in arthroscopic surgery, which have suggested the risk factors are tourniquet time more than 60 min [2] , prior history of DVT [9] , and age more than 40 years [3] . This patient had two of these risk factors, as she was over 40 years of age and the operation and tourniquet time were over 60 min.…”

“…The risk factors are age greater than 40–60 years [1] , [2] and operation time more than 60–120 min. [1] , [3] There have been three reported cases of DVT after arthroscopic meniscal procedure, all related to arthroscopic meniscectomy. Two of these three cases had had combined DVT and symptomatic pulmonary embolism (PE) which occurred at 9 and 21 days after their surgeries [4] , [5] , while the other had only DVT, diagnosed after presenting with leg swelling 13 days following the surgery.…”