Low incidence of deep vein thrombosis after knee arthroscopy without thromboprophylaxis: A prospective cohort study of 335 patients (original) (raw)
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Symptomatic Deep Vein Thrombosis Following Elective Knee Arthroscopy Over the Age of 40
Clinical and Applied Thrombosis/Hemostasis
Thromboprophylaxis following arthroscopic knee surgery (AKS) is not clear in the literature. The purpose of this study was to present the incidence of symptomatic deep vein thrombosis (DVT) following elective AKS over the age of 40. The secondary purpose was to investigate risk factors associated with venous thromboembolic events (VTEs). Surgical database and outpatient clinic follow-up charts of the patients who underwent AKS for any reason were included in the study. Odds for risk factors such as previous medical history of thrombosis, any family history for clotting disorders, diabetes mellitus (DM), oral contraceptive usage, body mass index, history of malignancy, and smoking were evaluated. The incidence of DVT following AKS significantly increased in the patients older than 40 years who had a previous medical history of VTE, DM, and smoking. A variety of guidelines exist for VTE prophylaxis; however, one should focus on risk factors related to the patient’s medical history and...
Deep Venous Thrombosis After Knee Arthroscopy: A Meta-analysis
Arthroscopy-the Journal of Arthroscopic and Related Surgery, 2005
Purpose: To establish a contemporary literature-based estimate of the incidence of deep venous thrombosis (DVT) after knee arthroscopic surgery. Methods: We performed a systematic review and meta-analysis of the English language literature to assess the efficacy of prophylaxis to prevent DVT after knee arthroscopic surgery. Only randomized controlled trials (RCTs) or prospective studies were considered. Studies were excluded if they were not original prospective studies concerning DVT detected by imaging after knee arthroscopic surgery. We calculated pooled proportions of postoperative DVT and proximal DVT. Results: Nine prospective uncontrolled studies and 4 RCTs were retrieved. Within them, the populations given low-molecular-weight heparin (LMWH) to prevent DVT had a 0.1% to 11.9% incidence of DVT, with an overall 36 DVTs identified (4 proximal), averaging 1.8%. One hundred thirty-six DVTs (29 proximal) were indicated in the populations without prophylaxis, and the DVT incidence varied from 1.8% to 41.2%, averaging 6.8%. Of the RCTs, the pooled risk ratio for DVT to develop was 0.180 (range, 0.065 to 0.499) for those who had LMWH as prophylaxis. An absolute risk reduction of 1.2%dfrom 1.5% to 0.3%dfor the development of proximal DVT was observed. Conclusions: Compared with patients who did not receive prophylaxis, the pooled risk ratio for the development of DVT was 0.18 for those who had LMWH prophylaxis. The incidence of proximal DVT is very low after arthroscopic surgery regardless of receiving prophylaxis (4 of 2,184) or not (29 of 1,814). The rate of proximal DVT in total DVT occurrence can be markedly reduced from 21.3% (29 of 136) to 11.1% (4 of 36). Level of Evidence: Level IV. This study is a metaanalysis of RCTs and a systematic review of Level IV studies.
Prevention of deep-vein thrombosis in ambulatory arthroscopic knee surgery
Arthroscopy-the Journal of Arthroscopic and Related Surgery, 2002
The risk of deep vein thrombosis (DVT) in patients undergoing arthroscopic knee surgery is not well known. The purpose of this study was to determine the incidence of DVT, to demonstrate the efficacy of a perioperative and postoperative prophylaxis against thromboembolism with use of low-molecular weight heparin (LMWH), and to show the safety and feasibility of LMWH administration. Type of Study: Prospective, single-blind, randomized clinical trial. Methods: There were 218 consecutive outpatients scheduled for ambulatory arthroscopic knee surgery eligible. Of these, 130 patients were randomized to a treatment group with LMWH (dalteparin: 2,500 IU Յ70 kg and 5,000 IU Ͼ70 kg, started perioperatively and given once daily for 4 weeks; n ϭ 66) and a control group (n ϭ 64) with no prophylaxis. To detect DVT, all patients underwent bilateral compression ultrasonography before and 12 and 31 days after surgery. Results: Among the 130 patients studied, thromboembolism was significantly lower in the treatment than in the control group: 1 of 66 (1.5%) versus 10 of 64 (15.6%); 95% confidence interval, 7.8% to 26.8%; P ϭ .004. Eighty percent of DVT occurred within the first 14 postoperative days. No severe side effects of LMWH were observed. Only 5% of patients refused continued subcutaneous LMWH injections. Conclusions: In patients undergoing ambulatory arthroscopic knee surgery without antithrombotic prophylaxis, the risk of DVT is high. Perioperative and postoperative prophylaxis with dalteparin is an effective and safe means of reducing this risk.
BMC Musculoskeletal Disorders
Background: We sought to document the incidences of deep vein thrombosis (DVT) before and after total knee arthroplasty (TKA). In addition, we aimed to explor whether routine preoperative DVT evaluation was useful to establish DVT treatment strategies after TKA. Finally, we wanted to evaluate whether the incidences of DVT differed between patients undergoing unilateral and staged bilateral TKA within the same hospitalization period. Methods: The retrospective study included 153 consecutive patients (253 knees) with osteoarthritis who underwent primary TKA. After surgery, mechanical compression devices (only) were used for DVT prophylaxis. DVT status before and after TKA was determined via 128-row, multidetector, computed tomography/indirect venography. Results: Overall, the preoperative DVT incidence was 2.6% per patient and 1.6% per knee. All preoperative DVTs were distal in nature and asymptomatic. After TKA, newly developed thrombi were evident in various calf veins, without propagation of any pre-existing thrombi. Postoperatively, the overall incidences of DVT were 69.9% per patient and 58.5% per knee. The DVT incidences were 66% per patient and 69.8% per knee in the unilateral TKA group. In contrast, the incidences were 72% per patient and 55.5% per knee in the staged bilateral TKA group. There was one case of symptomatic distal (unilateral TKA; 0.65% per patient and 0.4% per knee) and proximal DVT (bilateral TKA; 0.65% per patient and 0.4% per knee), respectively. Conclusions: The incidence of symptomatic DVT was low in Asian patients treated with mechanical compression devices alone, although substantial portion of patients had DVT after surgery. Routine preoperative DVT evaluation is probably not necessary; preoperative DVT was rare and of limited clinical relevance. Furthermore, staged bilateral TKA during a single period of hospitalization does not increase the incidence of DVT.
The Journal of Arthroplasty, 2008
Our objective of the study was to address the question: "What is the efficacy of a deep venous thrombosis (DVT) and pulmonary embolus prophylaxis protocol after total knee arthroplasty (TKA) in which low-risk patients had only aspirin and mechanical devices for prophylaxis?" A multimodal approach to DVT prophylaxis using aspirin as the primary mode of chemoprophylaxis was successful in preventing DVT-related morbidity and mortality in 312 consecutive TKAs performed in low-risk patients. There were no DVT-related deaths and no deaths in general at 90 days of follow-up coupled with a low rate of readmission for thromboembolic events and no readmissions or reoperations from bleeding in this group. This lowmorbidity, low-cost prophylaxis should be considered an appropriate protocol for low-risk patients undergoing TKA. Of all TKAs performed during the time period of the study, 73% qualified for the low-risk group.
2014
Background: Deep venous thrombosis (DVT), which is often associated with pulmonary embolism (PE), is a serious complication after total knee arthroplasty (TKA). In the present study, we examined the overall thrombotic and thrombolytic status using Global Thrombosis Test (GTT) in non-anticoagulated blood of patients undergoing TKA to develop the predictable marker for the incidence of DVT. Methods: DVT was diagnosed using doppler ultrasonography a day after the surgery in 31 patients with osteoarthritis (n = 24), rheumatoid arthritis (n = 6) and ankylosing spondylitis (n = 1) by the well-trained operator. We measured overall thrombotic and thrombolytic status using GTT and other biomarkers, which is associated with blood coagulation and fibrinolysis, before and immediately after the surgery. Results: Newly-generated DVT during the operation was detected in 11 of 31 patients (35.4%) 1 day after TKA. There were no differences in markers of coagulation (PT and APTT), platelet activity (platelet aggregation-induced by ADP and collagen) and fibrinolysis (FDP and D-dimer) between non-DVT and DVT group both before and after the surgery. Both Pre-and Post-operative GTT-occlusion times (OT), an index of platelet reactivity, were tended to be shorter, but not significant, in DVT group compared with non-DVT group. Pre-operative GTT-lysis time (LT), an index of thrombolytic activity, was significantly shorter in DVT group compared with non-DVT group, while there were no differences in post-operative value of this index between DVT group and non-DVT group, suggesting overall thrombolytic activity was enhanced in DVT group before surgery. Conclusions: Our data suggest that enhancement of pre-operative thrombolytic activity assessed by GTT may be a predictable marker for the incidence of DVT after TKA.
Journal of Orthopaedic Surgery
Purpose: This study reports the results of a multimodal thromboprophylaxis protocol for lower limb arthroplasty involving risk stratification, intraoperative calf compression, aspirin prophylaxis and early (within 4 h) post-operative mobilisation facilitated by the use of local infiltration analgesia. The study also aimed to identify risk factors for venous thromboembolism (VTE) within a 3-month period following surgery for patients deemed not at elevated risk. Methods: Patients undergoing knee/hip arthroplasty or hip resurfacing were preoperatively screened for VTE risk factors, and those at standard risk were placed on a thromboprophylaxis protocol consisting of intraoperative intermittent calf compression during surgery, 300 mg/day aspirin for 6 weeks from surgery and early mobilisation. Patients were screened bilaterally for deep vein thrombosis (DVT) on post-operative days 10–14. If proximal DVT was detected, patients were anticoagulated and outcomes were recorded. Symptomatic ...