Venous Thromboembolism in Korean Patients Undergoing Major Orthopedic Surgery: A Prospective Observational Study using Computed Tomographic (CT) Pulmonary Angiography and Indirect CT Venography

Abstract

In patients undergoing major orthopedic surgery, data of deep venous thrombosis (DVT) and pulmonary embolism (PE) are lacking as studied by computed tomographic (CT) pulmonary angiography and indirect CT venography (CTPA-CTV). A prospective observational study was performed for 363 Korean patients undergoing major orthopedic surgery to determine the incidence of venous thromboembolism (VTE), especially proximal DVT and PE. The incidence of VTE was 16.3% (n=59). Of them, 8 patients (2.2%) were symptomatic. The rate of VTE was the highest in patients who underwent total knee replacement (40.4%), followed by hip fracture surgery (16.4%), and total hip replacement (8.7%; P<0.001). The incidence of PE was 6.6% (n=24). Of them, 4 patients (1.1%) were symptomatic. Forty-one patients (11.3%) were in the proximal DVT or PE group. Based on multivariate analysis, total knee replacement and age ≥65 yr were significant risk factors for proximal DVT or PE in patients undergoing major orthopedic surgery (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.1-5.1; P=0.025; and OR, 2.1; 95% CI, 1.0-4.4; P=0.046, respectively). Taken together, the overall incidence of PE was 6.6% and rate of symptomatic PE rate was 1.1%. Knee joint replacement and age ≥65 yr were significant risk factors for proximal DVT or PE.

Incidence of Deep Vein Thrombosis and Pulmonary Embolus Following Periacetabular Osteotomy

“…Multiple clinical studies have described the incidence of symptomatic venous thromboembolism with use of standard clinical signs and symptoms instead of venography as an end point. A prospective study from Korea confirmed the diagnosis of venous thromboembolism with use of CT phlebography and pulmonary angiography and demonstrated the lowest rate following total hip arthroplasty (8.5%) compared with total knee arthroplasty and hip fracture surgery 11 . These finding are supported by a prospective multinational Asian study also demonstrating a lower rate of venous thromboembolism following total hip replacement compared with total knee replacement and hip fracture surgery 12 .…”

Venous Thromboembolism in Japanese Patients with Fractures of the Pelvis and/or Lower Extremities Using Physical Prophylaxis Alone

“…[18][19][20][21][22][23][24][25] Nonetheless, our findings in the Japanese patients demonstrated similar incidence, which is consistent with other recent studies. [26][27][28][29][30][31] Thus, the use of anti-coagulation may be appropriate for Japanese fracture patients, especially those with multiple fractures, pelvic fractures, femoral shaft fractures, and hip fractures. Surgeons should be vigilant for VTE during the first 2 weeks after injury, especially in patients with multiple and/or pelvic fractures.…”

“…[18][19][20][21][22][23][24][25] Nonetheless, recent reports have shown a similar incidence in Asian and western patients undergoing hip fracture surgery or joint replacement. [26][27][28][29][30][31] The incidence of VTE in pelvic and acetabular fractures among Asians remains unclear. In Japan, physical prophylaxis has been the mainstay of VTE prevention, until fondaparinux sodium and enoxaparin became commercially available since 2007 and 2008, respectively.…”

Perfil epidemiológico dos pacientes submetidos à artroplastia de joelho do serviço de fisioterapia em hospital público de Santo André-SP

“…Em relação a deiscência, foi encontrado a incidência em 8,4% dos casos, aderência cicatricial 2,7% e erisipela em 2,7% dos casos, entretanto, não houve relatos descritos a respeito destas três complicações nos artigos selecionados. Segundo Cha et al 20 a trombose venosa profunda (TVP) apresenta alta frequência em grandes cirurgias ortopédicas, com destaque para ATJ, onde os fatores de risco são idade igual ou maior que 65 anos e a substituição da articulação do joelho 20 . Encontrou-se uma frequên-cia de TVP em 5,4% nos casos estudados, próximo dos valores descritos por Carvalho Jr et al (4,2%), entretanto, outros autores negam a frequencia de TVP em suas pesquisas 17 , ou não relatam 13 .…”