Incidence and Fate of “Symptomatic” Venous Thromboembolism After Knee Arthroplasty Without Pharmacologic Prophylaxis in an Asian Population

Park, Yong Bum; Ha, Chul‐Won; Lee, Sung-Sahn; Shaikh, Aseem

doi:10.1016/j.arth.2015.11.028

Cited by 21 publications

(25 citation statements)

References 29 publications

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“…Owing to low incidence of DVT in Asian population, routine chemoprophylaxis was not warranted. 18 Pneumatic calf pumps were used in all patients until they started ambulation. Chemical prophylaxis using low-molecular-weight heparin was given only in high-risk patients screened preoperatively.…”

Section: Methodsmentioning

confidence: 99%

Is Combined Administration of Tranexamic Acid Better than Both Intravenous and Topical Regimes for Total Loss, Hidden Loss and Post-operative Swelling? A Randomized Control Trial

Prakash

Seon

Song

et al. 2018

IJOO

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Section: Methodsmentioning

confidence: 99%

Is Combined Administration of Tranexamic Acid Better than Both Intravenous and Topical Regimes for Total Loss, Hidden Loss and Post-operative Swelling? A Randomized Control Trial

Prakash

Seon

Song

et al. 2018

IJOO

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“…Mechanical DVT prophylaxis using a pneumatic compression device was performed in all patients. Considering the low incidence of DVT in Asian populations26), routine use of pharmacological prophylaxis was not prescribed according to our institutional policy. Routine screening for DVT was not done for asymptomatic patients.…”

Section: Methodsmentioning

confidence: 99%

Effect of Tranexamic Acid on Blood Loss and Blood Transfusion Reduction after Total Knee Arthroplasty

Seol

Seon

Lee

et al. 2016

Knee Surg Relat Res

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PurposeTotal knee arthroplasty (TKA) accompanies the risk of bleeding and need for transfusion. There are several methods to reduce postoperative blood loss and blood transfusion. One such method is using tranexamic acid during TKA. The purpose of this study was to confirm whether tranexamic acid reduces postoperative blood loss and blood transfusion after TKA.Materials and MethodsA total of 100 TKA patients were included in the study. The tranexamic acid group consisted of 50 patients who received an intravenous injection of tranexamic acid. The control included 50 patients who received a placebo injection. The amounts of drainage, postoperative hemoglobin, and transfusion were compared between the groups.ResultsThe mean amount of drainage was lower in the tranexamic acid group (580.6±355.0 mL) than the control group (886.0±375.5 mL). There was a reduction in the transfusion rate in the tranexamic acid group (48%) compared with the control group (64%). The hemoglobin level was higher in the tranexamic acid group than in the control group at 24 hours postoperatively. The mean units of transfusion were smaller in the tranexamic acid group (0.76 units) than in the control group (1.28 units).ConclusionsOur data suggest that intravenous injection of tranexamic acid decreases the total blood loss and transfusion after TKA.

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“…Postoperative VTE in arthroplasty of the lower extremities remains as a severe complication. Because TKA is widely performed in the elderly populations, it is important to determine the combined use of pharmacological and mechanical prophylaxis . Until now, a few studies have evaluated platelet hyperreactivity in venous thrombosis; however, its role in postoperative VTE has not been established .…”

Section: Discussionmentioning

confidence: 99%

“…The use of pharmacologic prophylaxis combined with mechanical prophylaxis is recommended by the clinical guidelines of the American Academy of Orthopaedic Surgeons (AAOS) clinical guidelines . However, the routine use of pharmacologic prophylaxis in Asian patients is still controversial because of an increased risk of bleeding due to pharmacologic agents and variable incidences of VTE, ranging from 1.8% to 35.7%, when mechanical prophylaxis alone was used . Previous history of VTE is a known indication for more potent anticoagulants, but other risk factors that require pharmacologic prophylaxis after TKA are not clearly defined in the Asian population …”

Section: Introductionmentioning

confidence: 99%

“…1 However, the routine use of pharmacologic prophylaxis in Asian patients is still controversial because of an increased risk of bleeding due to pharmacologic agents and variable incidences of VTE, ranging from 1.8% to 35.7%, when mechanical prophylaxis alone was used. [2][3][4][5] Previous history of VTE is a known indication for more potent anticoagulants, but other risk factors that require pharmacologic prophylaxis after TKA are not clearly defined in the Asian population. 6 Hemostasis and inflammation are linked; therefore, surgical trauma-related perioperative inflammatory state increases blood coagulability.…”

Section: Introductionmentioning

confidence: 99%

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The role of platelet hyperreactivity in venous thromboembolism after total knee arthroplasty in elderly population without pharmacologic prophylaxis: A single‐center study

Kim

Park

Joo

et al. 2018

Int J Lab Hematology

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Introduction While it is suggested that platelet hyperreactivity plays a role in the arterial thrombi, its link with venous thromboembolism (VTE) is not well defined. Aggregometry using low concentrations of agonists is proposed as a reliable method to detect hyperreactivity. The aim of this study was to examine whether platelet hyperreactivity affects the development of VTE after total knee arthroplasty (TKA). Methods Total 150 elderly patients without VTE history were enrolled. Mechanical prophylaxis was used for VTE after TKA. We performed platelet aggregation using Chrono‐log (Chrono‐log Corporation, USA) in the presence of low concentrations of ADP (1.0 μmol/L) and epinephrine (0.4, 1.0 μmol/L), and measured maximal aggregation (%). Results At 0.4 μmol/L epinephrine, 69.3%, 15.3%, and 15.3% displayed low (<40%), moderate (40‐60%), and high (>60%) levels of aggregation, respectively. The proportion of high level of aggregation was 36.7%, 30.7% at 1.0 μmol/L of epinephrine and ADP, respectively. The incidence of VTE was higher in the moderate/high aggregation group (10/46, 21.7%) than in the low aggregation group (1/104, 1.0%) at 0.4 μmol/L epinephrine (P < 0.0001). In predicting postoperative VTE, sensitivity and specificity of ≥40% aggregation at 0.4 μmol/L epinephrine were 90.9% and 74.1%. Higher mean platelet volume and lower volume of blood loss were seen in the high aggregation group than in the low aggregation group. Conclusion Aggregation response to 0.4 μmol/L epinephrine is an optimal assay to classify platelet activity. Platelet hyperreactivity may increase the risk of postoperative VTE in an elderly population, and can be an indication of pharmacologic prophylaxis.

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Incidence and Fate of “Symptomatic” Venous Thromboembolism After Knee Arthroplasty Without Pharmacologic Prophylaxis in an Asian Population

Cited by 21 publications

References 29 publications

Is Combined Administration of Tranexamic Acid Better than Both Intravenous and Topical Regimes for Total Loss, Hidden Loss and Post-operative Swelling? A Randomized Control Trial

Is Combined Administration of Tranexamic Acid Better than Both Intravenous and Topical Regimes for Total Loss, Hidden Loss and Post-operative Swelling? A Randomized Control Trial

Effect of Tranexamic Acid on Blood Loss and Blood Transfusion Reduction after Total Knee Arthroplasty

The role of platelet hyperreactivity in venous thromboembolism after total knee arthroplasty in elderly population without pharmacologic prophylaxis: A single‐center study

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