Incidence and natural history of deep-vein thrombosis after total hip arthroplasty

Kim, Y.-H.; Oh, S.-H.; Kim, J.-S.

doi:10.1302/0301-620x.85b5.14012

Cited by 91 publications

(26 citation statements)

References 53 publications

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“…Further research is needed to determine the risk/benefit profile for the treatment of small and/or isolated subsegmental clots and determine if patients diagnosed with only small tertiary pulmonary emboli would benefit from not being treated. In our study, the overall incidence of detected PE was approximately 0.5%, which is an incidence consistent with that reported in the literature [2][3][4].…”

Section: Discussionsupporting

confidence: 92%

“…Because of the low overall incidence of PE [1][2][3][4], it is unreasonable to perform postoperative CT scans on all orthopedic patients or even all patients who have undergone higher risk procedures like total joint arthroplasty. Such an approach would increase the risk of unnecessary radiation exposure to patients and would be imprudent from a cost-benefit analysis of health care.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of DVT in patients without prophylaxis is 40-84% for total knee replacement [1] and 39-74% for total hip replacement [2]. The incidence of fatal PE following total joint replacement has ranged from 0.19% to 3.4% [2][3][4], and the incidence of asymptomatic PE has been reported to be as high as 12% [1]. Trauma patients also have notoriously high rates of DVT, although these clots are often detected prior to any fracture fixation procedures.…”

Section: Introductionmentioning

confidence: 99%

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Detection of Pulmonary Embolism in the Postoperative Orthopedic Patient Using Spiral CT Scans

et al. 2009

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Orthopedic surgery is associated with a significant risk of postoperative pulmonary embolism (PE) and/or deep vein thrombosis (DVT). This study was performed to compare the clinical presentations of a suspected versus a documented PE/DVT and to determine the actual incidence of PE/DVT in the post-operative orthopedic patient in whom CT was ordered. All 695 patients at our institution who had a postoperative spiral CT to rule out PE/DVT from March 2004 to February 2006 were evaluated and information regarding their surgical procedure, risk factors, presenting symptoms, location of PE/DVT, and anticoagulation were assessed. Statistical analysis was performed using an independent samples t test with a two-tailed p value to examine significant associations between the patient variables and CT scans positive for PE. Logistic regression models were used to determine which variables appeared to be significant predictors of a positive chest CT. Of 32,854 patients admitted for same day surgery across all services, 695 (2.1%) had a postoperative spiral CT based on specific clinical guidelines. The incidence of a positive scan was 27.8% (193/695). Of these, 155 (22.3%) scans were positive for PE only, 24 (3.5%) for PE and DVT, and 14 (2.0%) for DVT only. The most common presenting symptoms were tachycardia (56%, 393/695), low oxygen saturation (48%, 336/695), and shortness of breath (19.6%, 136/695). Symptoms significantly associated with DVT were syncope and chest pain. A past medical history of PE/DVT was the only significant predictor of a positive scan. Patients who have a history of thromboembolic disease should be carefully monitored in the postoperative setting.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Detection of Pulmonary Embolism in the Postoperative Orthopedic Patient Using Spiral CT Scans

et al. 2009

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“…First, subjects of this study were all Japanese and the incidence of DVT may differ among various ethnic groups. Kim et al reported that Koreans undergoing THA have a low incidence of DVT [16,17], although others have reported that the incidence of DVT appears similar between Asian and Western populations [22]. We therefore cannot say whether the incidence in our population in fact differs from that of other populations.…”

Section: Discussionmentioning

confidence: 68%

Thrombophylaxis with low-dose, short-term fondaparinux after elective hip surgery

Tsuda

Nishii

Sakai

et al. 2015

J Thromb Thrombolysis

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Some studies have cautioned about the possibility of bleeding complications with routine use of anticoagulants like fondaparinux (FPX) for thrombophylaxis after elective hip surgery. Overdosing or prolonged periods of anticoagulant use should be avoided. We trialed a new regimen using FPX and tranexamic acid (TA) to reduce the risk of bleeding complications while maintaining efficacy in preventing deep vein thrombosis (DVT). The present study evaluated the effectiveness and safety of this regimen in 391 consecutive patients. Each patient was assigned either the FPX group, administered a once-daily subcutaneous injection of 1.5 mg of FPX on postoperative days 2, 3, and 4; or the intermittent pneumatic compression (IPC) group, which used an IPC device continuously for 1-2 days with no administration of any anticoagulant drugs. Ultrasonography was performed to diagnose DVT in all patients. No cases of fatal or symptomatic pulmonary embolism were encountered in either group, but six patients (3.1 %) in the FPX group and nine patients (6.0 %) in the IPC group showed asymptomatic distal DVT. The incidence of DVT tended to be lower (p = 0.19), volumes of intraoperative (p < 0.01) and postoperative (p < 0.01) blood loss were significantly smaller, and hemoglobin level was significantly higher in the FPX group than in the IPC group (p < 0.01). Our new thrombophylactic regimen using FPX and TA appears effective and safe for use after elective hip surgery.

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“…[6][7][8] Ultra Sound Doppler has the sensitivity of 63%-94% to detect deep venous thrombosis as quoted in a meta-analysis. 9 There is a clear guideline on the preventive aspect of this complication as given by both AAOS and NICE.…”

Section: Discussionmentioning

confidence: 98%

Is deep venous thrombosis a common complication in patients treated with Ilizarov external fixator?

Reddy¹,

Shah²,

Kumar³

et al. 2017

Int J Res Orthop

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Background: Determining the incidence of deep venous thrombosis (DVT), a prospective study, in patients treated with Ilizarov external fixators for lower extremity fractures, fracture non unions or deformity correction.Methods: A Prospective, observational and cross sectional study. 49 Patients with complex lower extremity injuries, deformities and non-union of fractures were treated with Ilizarov external fixator application, were assessed clinically and radiological (Venous Doppler) at regular intervals- 6 days post-surgery then at 6 weeks, 12 weeks and between 4 to 6 months post-operative. None were given chemoprophylaxis for the prevention of DVT and everyone were assessed pre operatively with a questionnaire and wells criteria was taken for assessment of high risk for developing venous thrombosis. There were 41 men and 8 women, 85.75% of the study group is of age 30 to 60 years.Results: Only 1 of 49 patients developed radiological evident DVT within 6 days of surgery. Patients who underwent application of Ilizarov external fixator electively for deformity correction, osteomyelitis and non-union showed no clinical or radiological evident signs of DVT.Conclusions: The incidence of DVT and PTE is minimal when patients without chemoprophylaxis underwent lower limb Ilizarov external fixator application for acute trauma and electively for deformity correction, treatment of non-union and osteomyelitis. However further comparative and randomized studies need to be done to confirm our results.

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Incidence and natural history of deep-vein thrombosis after total hip arthroplasty

Cited by 91 publications

References 53 publications

Detection of Pulmonary Embolism in the Postoperative Orthopedic Patient Using Spiral CT Scans

Detection of Pulmonary Embolism in the Postoperative Orthopedic Patient Using Spiral CT Scans

Thrombophylaxis with low-dose, short-term fondaparinux after elective hip surgery

Is deep venous thrombosis a common complication in patients treated with Ilizarov external fixator?

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