Risk factors for venous thromboembolism after total hip and total knee arthroplasty: a meta-analysis

Zhang, Jie; Chen, Zhihao; Zheng, Jilin; Breusch, Steffen; Tian, Jinhui

doi:10.1007/s00402-015-2208-8

Cited by 83 publications

(93 citation statements)

References 42 publications

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“…However, some studies came to the reverse conclusion that diabetes mellitus was not a risk factor of VTE . In a meta‐analysis conducted by Zhang et al , the authors pooled 14 studies to identify the risk factors for VTE after total hip arthroplasty (THA) or total knee arthroplasty (TKA), and they found no correlation between diabetes mellitus and postoperative VTE (odd ratio (OR) = 1·02, 95%CI: 0·80·1.31; P = 0·88). However, these estimates were calculated based on five studies, while our result was based on 14 studies, and no heterogeneity was identified between them.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors for venous thromboembolism following surgical treatment of fractures below the hip: a meta‐analysis

Tan

et al. 2016

International Wound Journal

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Venous thromboembolism (VTE) is a common complication after surgical treatment of fractures, which is associated with significant morbidity and mortality. Identifying the risk factors for VTE is important for preventive strategies to reduce the incidence of VTE. Therefore, we conducted a meta-analysis to evaluate the incidence of VTE and the risk factors influencing the development of VTE in patients who underwent surgery for fractures below the hip. PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, China) and CNKI (National Knowledge Infrastructure, China) databases were systematically searched to identify cohort or case-control studies that investigated the incidence and risk factors for VTE following surgical treatment of fractures below the hip. VTE risk ratios (RRs) were pooled by use of a fixed-effect model or a random-effect model, depending on the heterogeneity among the included studies. Heterogeneity between the studies was assessed by I statistics. Twenty-three studies with a total of 191 294 patients who met the inclusion criteria were included in this meta-analysis. Our results demonstrated that age (≥60 years) (RR = 1·85, 95% confidence interval (CI): 1·34, 2·55; P = 0·000), previous VTE(RR = 5·25, 95% CI: 2·77, 9·96; P = 0·000), heart failure (RR = 1·74, 95% CI: 1·34, 2·27; P = 0·000), current smoking status (RR = 1·23, 95% CI: 1·07, 1·41; P = 0·004), hypertension (RR = 1·62, 95% CI: 1·27, 2·06; P = 0·000), hyperlipidaemia (RR = 2·16, 95% CI: 1·79, 2·62; P = 0·000), diabetes mellitus (RR = 1·46, 95% CI: 1·27, 1·68; P = 0·000), obesity (RR = 1·58, 95% CI: 1·35,·1·85; P = 0·000), multiple fractures (RR = 2·14, 95% CI: 1·00, 4·60; P = 0·050), varicose veins (RR = 3·07, 95% CI: 1·12, 8·47; P = 0·030), prolonged operation time (weighted mean differences (WMD) = 1·22, 95% CI: 0·63, 1·81; P = 0·000) and prolonged bed rest time (WMD = 3·12, 95% CI: 2·96, 3·29; P = 0·000) were associated with an increased risk of developing VTE. The other variables, including age (<60 years), previous smoking, immobility, pregnancy, cancer, open fractures and combination with trauma were not identified as significant risk factors for VTE. Almost all the risk factors mentioned above are in line with the known risk factors for VTE following surgery for fractures below the hip. Thus, surgeons should pay close attention to patients with these medical conditions in order to reduce the incidence of VTE following surgical treatment of fractures below the hip.

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Section: Discussionmentioning

confidence: 99%

Incidence and risk factors for venous thromboembolism following surgical treatment of fractures below the hip: a meta‐analysis

Tan

et al. 2016

International Wound Journal

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“…Advanced age >70 years, female sex, obesity, and hypertension have been known as risk factors of VTE after TKA . In this study, platelet aggregation ≥40% was more frequently observed in patients with VTE, while the incidences of these risk factors were not significantly higher.…”

Section: Discussionmentioning

confidence: 44%

“…The same surgeon performed all surgical procedures. Patients with major risk factors for development of postoperative VTE (a history of VTE, presence of cancer, steroid use, thrombophilic disorders, congestive heart failure, and atrial fibrillation) were excluded . Demographics including body mass index (BMI), diabetes mellitus, hypertension, and history of coronary artery disease (CAD) or ischemic stroke (IS) were reviewed through medical records.…”

Section: Methodsmentioning

confidence: 99%

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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“…. Cardiac failure, respiratory disorders and renal diseases have been associated with an increased VTE risk after hip or knee arthroplasty . Renal diseases (mostly with impaired renal function) may also have prevented the use of low molecular weight heparins which are contraindicated in this context.…”

Section: Discussionmentioning

confidence: 99%

Thromboembolic risk after lumbar spine surgery: a cohort study on 325 000 French patients

Bouyer

Rudnichi

Dray‐Spira

et al. 2018

Journal of Thrombosis and Haemostasis

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Background Postoperative venous thromboembolism (VTE) is a severe complication, the risk of which after lumbar spine surgery (LBS) is not precisely known. Objective To estimate the incidence of VTE after LBS, and to identify individual and surgical risk factors. Methods All patients aged >18 years who underwent LBS in France between 2009 and 2014 were identified. Among 477 024 patients screened, exclusions concerned recent VTE or surgery, and multiple surgeries during the same hospital stay. Results In 323 737 patients (mean age 52.9 years, 51.4% male), we observed 2911 events (0.91%) after a median time of 12 days (Q1-Q3: 5-72 days). The multivariate adjusted Cox model showed increased risks associated with age (4% per year of age; 95% confidence interval [CI] 3.8-4.3), obesity (hazard ratio [HR] 1.32, 95% CI 1.18-1.46), active cancer (HR 1.65, 95% CI 1.5-1.82), previous thromboembolism (HR 5.41, 95% CI 4.74-6.17), severe paralysis (HR 1.47, 95% CI 1.17-1.84), renal disease (HR 1.28, 95% CI 1.04-1.6), psychiatric disease (HR 1.21, 95% CI 1.1-1.32), use of antidepressants (HR 1.13, 95% CI 1.03-1.24), use of contraceptives (HR 1.56, 95% CI 1.19-2.03), extended surgery for scoliosis (HR 3.61, 95% CI 2.96-4.4), implantation of pedicular screws with a 'dose-effect' association, and an anterior approach (HR 1.97, 95% CI 1.6-2.43) or a combined approach (HR 2.03, 95% CI 1.44-2.84). Conclusions The overall VTE risk after LBS is moderate (< 1%) but is widely modulated by several easily identifiable risk factors. The surgical community should be aware of this heterogeneity, adapt prevention according to patients and to the procedure, and use drug prophylaxis in the event of a high risk being present.

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Risk factors for venous thromboembolism after total hip and total knee arthroplasty: a meta-analysis

Cited by 83 publications

References 42 publications

Incidence and risk factors for venous thromboembolism following surgical treatment of fractures below the hip: a meta‐analysis

Incidence and risk factors for venous thromboembolism following surgical treatment of fractures below the hip: a meta‐analysis

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

Thromboembolic risk after lumbar spine surgery: a cohort study on 325 000 French patients

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