Venous Thromboembolism Following Hip and Knee Replacement Arthroplasty in Korea: A Nationwide Study Based on Claims Registry

Abstract

The aim of this study was to examine the incidence and trends of clinically relevant venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) after hip and knee replacement arthroplasty (HKRA) in Korea. Between January 1 and December 31, 2010, 22,127 hip replacement arthroplasty (HRA) patients and 52,882 knee replacement arthroplasty (KRA) patients were enrolled in the analysis using the administrative claims database of the Health Insurance Review and Assessment Service (HIRA). All available parameters including procedure history and clinically relevant VTE during the 90 days after HKRA were identified based on diagnostic and electronic data interchange (EDI) codes. The overall incidence of VTE, DVT, and PE during the 90 days was 3.9% (n=853), 2.7% (n=597), and 1.5% (n=327) after HRA, while the incidence was 3.8% (n=1,990), 3.2% (n=1,699), and 0.7% (n=355) after KRA. The incidence of VTE after HKRA was significantly higher in patients who had previous VTE history (odds ratio [OR], 10.8 after HRA, OR, 8.5 after KRA), chronic heart failure (2.1, 1.3), arrhythmia (1.8, 1.7), and atrial fibrillation (3.4, 2.1) than in patients who did not. The VTE incidence in patients with chemoprophylaxis was higher than that in patients without chemoprophylaxis. The incidence of VTEs revealed in this retrospective review was not low compared with the results of the studies targeting other Asian or Caucasian populations. It may warrant routine prevention including employment of chemoprophylaxis. However, the limitation of the reviewed data mandates large scale prospective investigation to affirm this observation.

Clinical outcomes and risk factors of thromboprophylaxis with rivaroxaban versus aspirin in patients undergoing hip arthroplasty in low‐incidence population: A nationwide study in Korea

“…The VTE incidence was 0.6% in the rivaroxaban cohort in this study, which was similar with that observed in the study with the pooled data of four RECORD clinical trials, which showed that the incidence of symptomatic VTE in rivaroxaban-treated patients 18 The incidence of VTE following hip arthroplasty in this study was lower than that of Lee et al, 19 which investigated the VTE incidence in a Korean population that underwent hip replacement arthroplasty with chemoprophylaxis using the HIRA database. The study showed the incidence of VTE, DVT, and PE as 7.0%, 5.1%, and 2.5%, respectively, which was higher than that observed with chemoprophylaxis (2.0%, 1.4%, and 0.9%, respectively).…”

“…The study showed the incidence of VTE, DVT, and PE as 7.0%, 5.1%, and 2.5%, respectively, which was higher than that observed with chemoprophylaxis (2.0%, 1.4%, and 0.9%, respectively). 19 The reported incidence was significantly higher than that in our present study. The different inclusion criteria of patient population of this study might explain this discrepancy.…”

“…The incidence of VTE following hip arthroplasty in this study was lower than that of Lee et al, which investigated the VTE incidence in a Korean population that underwent hip replacement arthroplasty with chemoprophylaxis using the HIRA database. The study showed the incidence of VTE, DVT, and PE as 7.0%, 5.1%, and 2.5%, respectively, which was higher than that observed with chemoprophylaxis (2.0%, 1.4%, and 0.9%, respectively) . The reported incidence was significantly higher than that in our present study.…”

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

“…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 …”

“…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.…”