Incidence and Time Course of Thromboembolic Outcomes Following Total Hip or Knee Arthroplasty

White, Richard; Romano, Patrick S.; Zhou, Hong; Rodrigo, Juan J.; Bargar, William L.

doi:10.1001/archinte.158.14.1525

Cited by 550 publications

(431 citation statements)

References 32 publications

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“…This is comparable to larger-scale studies that reported clinically symptomatic DVT incidences of 2.1%, 2.8% and 3.7% for patients who underwent arthroplasty. (9,12,13) However, the patients in those studies had both mechanical and chemical thromboprophylaxis, while the patients in the present study only had mechanical prophylaxis.…”

Section: Discussionmentioning

confidence: 69%

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

Yeo

Lim

Lee

2016

smedj

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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.

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Section: Discussionmentioning

confidence: 69%

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

Yeo

Lim

Lee

2016

smedj

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“…Incomplete data collection, uncertain compliance and accuracy of coding related to diagnosis and procedures performed, and lack of detailed clinical information are all concerns. White et al [31] have reported on the limitations of using the NIS for reporting PE (current versus historic embolism) and it is likely that this is reflected in our data. Also, with the current data, it is not possible to assess which PEs are clinically significant and which are not.…”

Section: Discussionmentioning

confidence: 86%

“…The rate of symptomatic VTE in patients undergoing TKA receiving prophylaxis is 1.3% to 2.3% [10,11,27]. The rate of PE in this population is generally reported with an incidence of less than 0.8% [6,31], although there has been inconsistency regarding the incidence of VTE in association with TJA over the last 10 to 15 years [2,16]. The purpose of this study was to analyze similar epidemiologic data as it pertains to patients undergoing primary TJA, specifically to assess the changing prevalence of PE along with the mortality, complications, and resource consumption associated with the treatment of PE after TJA both before and after the introduction of CTPA using a large, nationally representative database.…”

Section: Discussionmentioning

confidence: 98%

CT Pulmonary Angiography After Total Joint Arthroplasty: Overdiagnosis and Iatrogenic Harm?

D’Apuzzo

Keller

Novicoff

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…One study with 49.7 months followup of 51 patients after THR or knee replacement was inconclusive on whether patients with asymptomatic DVT were more likely to have symptomatic DVTs [31]. Nevertheless, clinical trials and observational studies have shown that patients with asymptomatic venous thrombosis in proximal veins are clearly at higher risk to develop clinical VTE [26,[32][33][34][35][36][37].…”

Section: Methodsmentioning

confidence: 99%

The true treatment benefit is unpredictable in clinical trials using surrogate outcome measured with diagnostic tests

Kassaï

Shah

Leizorovicza

et al. 2005

Journal of Clinical Epidemiology

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Background and Objectives-Clinical trials increasingly use results of diagnostic tests as surrogate outcomes. Our objective was to answer the following questions: (1) is the parameter measured by the reference standard a valid surrogate? (2) How does the tests accuracy influence the estimate of the treatment benefit on surrogate? (3) Is it possible to correct the measured treatment effect given by results of inaccurate tests?Methods and Setting-We reviewed the literature on asymptomatic deep venous thrombosis (DVT), detected by the reference standard and other imaging techniques, as surrogate for venous thromboembolism. The influence of test inaccuracy on the measurement of treatment benefit was calculated as a function of the patient baseline risk, the treatment effect model, and test performances.Results-We show that: (1) asymptomatic DVT is correlated with clinical outcomes but is yet to be established as a surrogate; (2) inaccurate diagnostic test underestimates the treatment effect on surrogate; (3) the prevalence of the disease, the treatment effect model, and the accuracy of the test and the reference standard used to evaluate it need to be known to correct this underestimation.Conclusion-Even when the surrogate end point is valid, without a reliable study of the diagnostic test we cannot quantify the true treatment effect.

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Incidence and Time Course of Thromboembolic Outcomes Following Total Hip or Knee Arthroplasty

Cited by 550 publications

References 32 publications

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

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

CT Pulmonary Angiography After Total Joint Arthroplasty: Overdiagnosis and Iatrogenic Harm?

The true treatment benefit is unpredictable in clinical trials using surrogate outcome measured with diagnostic tests

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