Publications (2)11.46 Total impact
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Article: Universal pharmacological thromboprophylaxis for total knee arthroplasty may not be necessary in low-risk populations: a nationwide study in Taiwan.
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ABSTRACT: Thromboprophylaxis should be universally administered in major orthopedic surgery. However, epidemiology of venous thromboembolism (VTE) following major knee surgery in Asia is scarce. To describe the use of thromboprophylaxis and calculate the incidence and risk factors of symptomatic VTE following major knee surgery in Taiwan. We used Taiwan's National Health Insurance Research Database to retrospectively identify patients (≥45 years) who underwent major knee surgery from 1998 to 2007 and collected the medical records within 3 months after the discharge. Logistic regression analysis was used to determine the risk factors of symptomatic VTE after the surgery. We identified 113 844 patients (mean age, 69.0 ± 7.7 years; female, 75.2%) receiving major knee arthroplasties. The mean length of stay was 9.1 ± 3.3 days. The overall pharmacological thromboprophylaxis rate was 2.2%. The 3-month cumulative incidence of procedure-related symptomatic VTE was 0.46% (95% CI, 0.42–0.50%). The median time to the first post-operation VTE was 7 days, with 85.4% occurring within 2 weeks after the discharge.Logistic regression analysis showed that previous VTE, malignancy, heart failure and neurologic disorder with extremity paralysis or pararesis were independent risk factors (P < 0.05) for symptomatic VTE following major knee arthroplasties. The thromboprophylaxis rate is low, which may be due to the very low incidence of symptomatic VTE after the surgery in Taiwan. Most symptomatic VTE occurred within 2 weeks after the surgery. Universal thromboprophylaxis for knee arthroplasties may not be necessary in Taiwan, but it should be considered in some high-risk populations.Journal of Thrombosis and Haemostasis 11/2011; 10(1):56-63. · 5.73 Impact Factor -
Article: Incidence and cumulative recurrence rates of venous thromboembolism in the Taiwanese population.
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ABSTRACT: Little information is available on the epidemiology of venous thromboembolism (VTE) in Asian populations. To investigate VTE incidence, VTE cumulative recurrence rates and risk factors for VTE recurrence among the adult Taiwanese population. This population-based cohort study used the Taiwanese National Health Insurance claims databases to identify 5347 adult patients (2463 men, 46.1%) with VTE diagnosed in 2001 and 2002. We calculated the crude incidence of VTE and its recurrence. We also conducted a nested case-control study (n = 3576) among this population to estimate the association between VTE recurrence and exposure to potential VTE risk factors by conditional logistic regression. The crude incidence of VTE was 15.9 per 100,000 person-years, and its recurrence rate was 5.1% per person-year. During 11 566 person-years of follow-up, the cumulative rates of VTE recurrence at 6, 12, 24, 36 and 47 months were 6.7%, 9.4%, 12.4%, 13.9%, and 14.4%, respectively. By conditional logistic regression, histories of VTE [adjusted odds ratio (OR) 1.71, 95% confidence interval (CI) 1.32-2.16] or malignant neoplasm (adjusted OR 1.64, 95% CI 1.26-1.99), major extremity trauma (adjusted OR 2.76, 95% CI 1.82-4.52), serious neurologic diseases (adjusted OR 1.43, 95% CI 1.12-1.84) or undergoing major surgery (adjusted OR 4.57, 95% CI 1.72-12.50) were associated with higher risks of VTE recurrence. The incidence of VTE is lower in the Taiwanese population than in Caucasians. Most VTE recurrences occur within 12 months, but they continue to occur beyond 1 year. The VTE recurrences are associated with malignancy, history of VTE, and major surgery after a previous VTE.Journal of Thrombosis and Haemostasis 03/2010; 8(7):1515-23. · 5.73 Impact Factor
