What’s new in VTE risk and prevention in orthopedic surgery

Kahn, Susan R.; Shivakumar, S

doi:10.1002/rth2.12323

Cited by 45 publications

(73 citation statements)

References 48 publications

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“…With the increase of age, the elasticity of blood vessels in patients decreases, the blood vessel walls are easily damaged, and elderly patients are prone to have primary diseases such as diabetes, which increases the incidence of DVT[ 27 ]. The results of our study are consistent with the findings of previous studies.…”

Section: Discussionmentioning

confidence: 99%

The deep vein thrombosis of lower limb after total hip arthroplasty: what should we care

Ning

2021

BMC Musculoskelet Disord

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Background Deep vein thrombosis (DVT) of lower limb is one of the common complications after total hip arthroplasty(THA), we aimed to evaluate the potential risk factors of DVT of lower limb in patients with THA, to provide insights into the management of THA. Methods Patients who underwent THA in our hospital from January 1, 2017 to November 30, 2020 were included. The personal characteristics and clinical data of DVT and no-DVT patients were compared and analyzed. Logistic regression analyses were perfomed to identify the potential risk factors of DVT in patients with THA. Results A total of 182 THA patients were included, the incidence of DVT of lower limb in patients with THA was 19.78 %. There were significant differences in the age, BMI, diabetes, number of replacement, duration of surgery, type of prosthesis and duration of days in bed between DVT and no-DVT patients(all P < 0.05). And there were no significant differences in the gender, hypertension, hyperlipidemia, preoperative D-dimer, type of anesthesia and anticoagulant drugs use(all P > 0.05). Logistic regression analysis indicated that age > 70y(OR4.406, 95 %CI1.744 ~ 6.134), BMI ≥ 28(OR2.275, 95 %CI1.181 ~ 4.531), diabetes(OR3.949, 95 %CI1.284 ~ 5.279), bilateral joint replacements(OR2.272, 95 %CI1.402 ~ 4.423), duration of surgery ≥ 120 min(OR3.081, 95 %CI1.293 ~ 5.308), cemented prosthesis(OR2.435, 95 %CI1.104 ~ 4.315), and duration of days in bed > 3 days(OR1.566, 95 %CI1.182 ~ 1.994) were the risk factors of DVT of lower limb in patients with THA. Conclusions DVT in the lower limb after THA is common, and its onset is affected by many factors. In clinical work, attention should be paid to identify the risk factors for DVT and targeted interventions are highlighted to prevent the postoperative DVT.

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Section: Discussionmentioning

confidence: 99%

The deep vein thrombosis of lower limb after total hip arthroplasty: what should we care

Ning

2021

BMC Musculoskelet Disord

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“…Considering the relatively high incidence of bleeding events, the current opinion is that individual risk analyses for VTE are needed [3,31]. In this regard, we are considering to design study protocols using LEX as mechanical prophylaxis according to VTE risk strati cation, in addition or not to pharmacological prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, in view of the current pandemic, it is worth noting that coronavirus disease 2019 (COVID- 19) increases the risk of VTE signi cantly [32,33]. In addition to this, self-isolation periods prior to lower limb arthroplasty may increase the thrombotic risk further [31]. In a period in which close contact should be reduced to a minimum, mechanical devices which enable self-managed exercise, such as the LEX, may be valuable for both a safe DVT prophylaxis and an appropriate rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Safety of a Novel Leg Exercise Apparatus for Venous Thromboembolism Prophylaxis After Total Joint Arthroplasty of the Lower Extremities

Kenta

Shimizu

Kamada

et al. 2021

Preprint

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Background: Venous thromboembolism (VTE) is a severe complication of orthopedic surgeries. Although mechanical measures such as graduated compression stockings and intermittent pneumatic compression are widely used for VTE prevention, complications (e.g. lower limb pain or skin disorders) may result from prolonged usage. Early postoperative ambulation and active ankle movements are recommended but have low patient acceptance due to surgical pain and the lack of motivation. To overcome these limitations, we developed a novel leg exercise apparatus (LEX) to encourage limb movement in bedridden patients in the early postoperative period in order to prevent VTE. Here, we aimed to evaluate the feasibility and safety of the LEX in individuals at high risk of deep vein thrombosis (DVT) postoperatively. Methods: Twenty subjects (4 men, 16 women) who underwent total joint arthroplasty in the lower extremity were enrolled in this prospective study. Exercise using LEX was performed for 5 minutes at 30 cycles/min, four times per day from postoperative days 1 to 7. Clinical assessments included the evaluation of vital signs before and after exercise with LEX, venous ultrasonography and blood tests within 7 days postoperatively, and evaluation of adverse events, including pulmonary embolism and cerebral hemorrhage.Results: Overall, 16/20 (80%) patients completed the exercise regimen of 7 days, while 4 dropped out. All four subjects who dropped out had undergone total hip arthroplasty; three of them refused to start exercises with LEX because of leg pain related to surgery. No severe adverse events occurred. There were no severe changes in vital signs. No DVT of the lower extremities was confirmed during postoperative week 1. The average preoperative D-dimer level was 0.85 µg/mL (range, 0.4-2.2), whereas the corresponding value in postoperative week 1 was 7.93 µg/mL (range, 2.0-13.8).Conclusions: In this study, no DVT cases or severe adverse events occurred postoperatively in patients undergoing total joint arthroplasty of the lower extremities who performed exercises with LEX. A study protocol analyzing the efficacy of this tool to prevent VTE after joint arthroplasty of the lower extremities may be safe and feasible.

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“…Safety is an increasingly important metric when evaluating the appropriateness of different chemoprophylactic agents given the relatively low rates of VTE after arthroplasty. A recent review of the use of aspirin after THA and TKA also concludes that, for appropriately selected low-risk patients, aspirin following rivaroxaban (as performed in a recent randomized trial [ 67 ]) is likely safe and effective [ 86 ].…”

Section: Discussionmentioning

confidence: 99%

An Update on Venous Thromboembolism Rates and Prophylaxis in Hip and Knee Arthroplasty in 2020

et al. 2020

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Patients undergoing total hip and knee arthroplasty are at high risk for venous thromboembolism (VTE) with an incidence of approximately 0.6–1.5%. Given the high volume of these operations, with approximately one million performed annually in the U.S., the rate of VTE represents a large absolute number of patients. The rate of VTE after total hip arthroplasty has been stable over the past decade, although there has been a slight reduction in the rate of deep venous thrombosis (DVT), but not pulmonary embolism (PE), after total knee arthroplasty. Over this time, there has been significant research into the optimal choice of pharmacologic VTE prophylaxis for individual patients, with the objective to reduce the rate of VTE while minimizing adverse side effects such as bleeding. Recently, aspirin has emerged as a promising prophylactic agent for patients undergoing arthroplasty due to its similar efficacy and good safety profile compared to other pharmacologic agents. However, there is no evidence to date that clearly demonstrates the superiority of any given prophylactic agent. Therefore, this review discusses (1) the current prevalence and trends in VTE after total hip and knee arthroplasty and (2) provides an update on pharmacologic VTE prophylaxis in regard to aspirin usage.

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What’s new in VTE risk and prevention in orthopedic surgery

Cited by 45 publications

References 48 publications

The deep vein thrombosis of lower limb after total hip arthroplasty: what should we care

The deep vein thrombosis of lower limb after total hip arthroplasty: what should we care

Feasibility and Safety of a Novel Leg Exercise Apparatus for Venous Thromboembolism Prophylaxis After Total Joint Arthroplasty of the Lower Extremities

An Update on Venous Thromboembolism Rates and Prophylaxis in Hip and Knee Arthroplasty in 2020

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