Risk factors for venous thromboembolism of total hip arthroplasty and total knee arthroplasty: a systematic review of evidences in ten years

Zhang, Zi-Hao; Shen, Bin; Yang, Jing; Zhou, Zongke; Kang, Pengde; Pei, Fuxing

doi:10.1186/s12891-015-0470-0

Cited by 75 publications

(71 citation statements)

References 69 publications

(154 reference statements)

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“…First, the small sample size made it difficult to determine the risk factors. Advanced age, female sex, higher BMI, and longer duration of operation have been reported as risk factors for VTE after TKA [17]. However, we did not observe the statistical differences in this study.…”

Section: Discussioncontrasting

confidence: 80%

The incidence of venous thromboembolism following total knee arthroplasty

Song

Rong

et al. 2016

Blood Coagulation &Amp; Fibrinolysis

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Venous thromboembolism (VTE), presenting as deep vein thrombosis (DVT) and pulmonary embolism, is one of the major complications following total knee arthroplasty (TKA). We conducted this prospective observational study to identify the prevalence of VTE among patients undergoing TKA by using computed tomographic pulmonary angiography in combination with bilateral lower limb venography. We enrolled consecutive patients admitted to our institution for primary unilateral TKA from September 2013 to July 2014. All participants underwent a standard surgical procedure of TKA. Computed tomographic pulmonary angiography and bilateral lower limb venography were performed within a week after the operation. We compared age, sex, BMI, comorbidities, data of laboratory tests, operation time and thromboprophylaxis between VTE group and non-VTE group to identify the risk factors. A total of 109 patients were enrolled in this study. The incidence of symptomatic DVT, asymptomatic DVT, symptomatic pulmonary embolism and asymptomatic pulmonary embolism following TKA was 4.6, 18.3, 1.8 and 1.8%, respectively. Elevated level of D-dimer was significantly associated with postoperative VTE. The incidence of VTE following TKA was high despite thromboprophylaxis, and asymptomatic DVTs accounted for a large proportion of thrombotic events.

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Section: Discussioncontrasting

confidence: 80%

The incidence of venous thromboembolism following total knee arthroplasty

Song

Rong

et al. 2016

Blood Coagulation &Amp; Fibrinolysis

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“…The patient received thromboprophylaxis to reduce the risk of DVT. However, obesity and gender (female vs male) are independent risk factors for DVT development in patients undergoing orthopedic surgery. This patient also had a low ADAMTS‐13 level around the time of the event.…”

Section: Discussionmentioning

confidence: 99%

Phase 3 study of recombinant von Willebrand factor in patients with severe von Willebrand disease who are undergoing elective surgery

Peyvandi

Мамаев

Wang

et al. 2019

Journal of Thrombosis and Haemostasis

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Summary Recombinant von Willebrand factor (rVWF) is effective in von Willebrand disease (VWD). A phase 3 study of rVWF, with/without recombinant factor VIII (rFVIII) before surgery in VWD. Overall rVWF's efficacy was rated excellent/good; rVWF was administered alone in most patients. rVWF was well‐tolerated and hemostasis was achieved in patients with severe VWD undergoing surgery. Summary BackgroundRecombinant von Willebrand factor (rVWF) has demonstrated efficacy for on‐demand treatment of bleeding in severe von Willebrand disease (VWD), warranting evaluation in the surgical setting. ObjectivesThis study (NCT02283268) evaluated the hemostatic efficacy/safety profile of rVWF, with/without recombinant factor VIII (rFVIII), in patients with severe VWD undergoing surgery. Patients/MethodsPatients received rVWF 40–60 IU kg−1, VWF ristocetin cofactor activity was measured 12–24 h before surgery. If endogenous FVIII activity (FVIII:C) target levels were achieved 3 h before surgery, rVWF was administered alone 1 h before surgery; rVWF was co‐administered with rFVIII if target endogenous FVIII levels were not achieved. rVWF was infused postoperatively to maintain target trough levels. Overall and intraoperative hemostatic efficacy, the pharmacodynamics of rVWF administration and the incidence of adverse events (AEs) were assessed. ResultsAll patients treated with rVWF for major (n = 10), minor (n = 4) and oral (n = 1) surgery had overall and intraoperative hemostatic efficacy ratings of excellent (73.3% and 86.7%) or good (26.7% and 13.3%). Most rVWF infusions (89.4%) were administered alone, resulting in hemostatically effective levels of endogenous FVIII within 6 h, which were sustained for 72–96 h; 70% (n = 7/10) of major surgeries were performed without rFVIII co‐administration. Six patients reported 12 treatment‐emergent AEs. Two patients each had one serious AE: diverticulitis (not treatment related) and deep vein thrombosis (sponsor‐assessed as possibly treatment related). No severe allergic reactions or inhibitory antibodies were reported. ConclusionsThese data support the efficacy and safety profile of rVWF in patients with severe VWD undergoing elective surgery.

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“…5 Part of the difficulty stems from the fact that symptomatic DVTs and PEs are rare complications, occurring in 0.8 to 1.8% of TKA patients. [6][7][8] Detecting a difference in venous thromboembolism (VTE) incidence between two cohorts, distinguished on the basis of either comorbidity or procedure type, requires a large study sample to provide adequate statistical power.…”

mentioning

confidence: 99%

Venous Thromboembolic Events after Total Knee Arthroplasty: Which Patients Are at a High Risk?

et al. 2019

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Venous thromboembolism (VTE; deep venous thrombosis and pulmonary embolism) is a known complication following primary total knee arthroplasty (TKA). The aim of this study was to investigate the trends of the incidence of VTE after primary TKA and identify associated risk factors for the occurrence of VTEs in a large cohort of TKA patients. We performed a retrospective study in which the Nationwide Inpatient Sample (NIS) database was used to identify all patients who underwent primary TKA over a period of 13 consecutive years (between 2002 and 2014) in the United States. The occurrence of a symptomatic VTE was identified with the use of ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnosis codes. A total of 1,460,901 primary TKA procedures were identified in the NIS from 2002 to 2014, and 12,944 of these patients were recorded as having 13,855 VTEs, consisting of 7,609 deep venous thromboses (0.52%) and 6,246 pulmonary emboli (0.43%). The overall VTE incidence in patients undergoing TKA in the United States from 2002 to 2014 was 0.89%. Patient-related risk factors for VTEs include an older age (odds ratio [OR]: 1.44; 95% confidence interval [CI]: 1.31–1.59), black race (OR: 1.34; 95% CI: 1.25–1.44), and Medicare insurance (OR: 1.18; 95% CI: 1.13–1.22). Most of the comorbidities were associated with an increased risk of VTE following TKA. Particularly, cardiac arrhythmias, coagulopathy, fluid and electrolyte disorders, pulmonary circulation disorders, and weight loss increased the risk of VTE by more than twofold. After adjusting for confounders, VTE was associated with a longer hospital stay (2.81 ± 0.02 day), increased costs (US$14,212.16 ± US$255.64), and higher mortality rate (OR: 13.04; 95% CI: 11.08–15.35). This nationally representative study of inpatients in the United States identified several independent risk factors for VTE perioperatively in TKA patients and provided evidence that VTE patients after TKA are likely to have worse results than non-VTE patients with regard to the length of hospital stay, hospital costs, and inhospital mortality. This is a level III, prognostic study.

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Risk factors for venous thromboembolism of total hip arthroplasty and total knee arthroplasty: a systematic review of evidences in ten years

Cited by 75 publications

References 69 publications

The incidence of venous thromboembolism following total knee arthroplasty

The incidence of venous thromboembolism following total knee arthroplasty

Phase 3 study of recombinant von Willebrand factor in patients with severe von Willebrand disease who are undergoing elective surgery

Venous Thromboembolic Events after Total Knee Arthroplasty: Which Patients Are at a High Risk?

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