Risk Factors for Venous Thromboembolism in Patients Undergoing Total Hip Replacement and Receiving Routine Thromboprophylaxis
Data on the risk factors for venous thromboembolism among patients undergoing total hip replacement and receiving pharmacological thromboprophylaxis are limited. The purpose of this study was to examine potential patient-related risk factors for venous thromboembolism following total hip replacement in a nationwide follow-up study. Using medical databases, we identified all patients who underwent primary total hip replacement and received pharmacological thromboprophylaxis in Denmark from 1995 to 2006. The outcome measure was hospitalization with venous thromboembolism within ninety days of surgery. We considered age, sex, indication for primary total hip replacement, calendar year of surgery, and comorbidity history as potential risk factors. The overall rate of hospitalization for venous thromboembolism within ninety days following a primary total hip replacement was 1.02% (686 hospitalizations after 67,469 procedures) at a median of twenty-two days. The incidence of symptomatic deep venous thrombosis and of nonfatal pulmonary embolism was 0.7% (499 of 67,469) and 0.3% (205 of 67,469), respectively. The incidence of death due to venous thromboembolism or from all causes was 0.05% (thirty-eight patients) and 1.0% (678 patients), respectively. Patients with rheumatoid arthritis had a reduced relative risk for venous thromboembolism compared with patients with primary osteoarthritis (adjusted relative risk = 0.47; 95% confidence interval, 0.25 to 0.90). Patients with a high score on the Charlson comorbidity index had an increased relative risk for venous thromboembolism compared with patients with a low score (adjusted relative risk = 1.45; 95% confidence interval, 1.02 to 2.05). Patients with a history of cardiovascular disease (relative risk = 1.40; 95% confidence interval, 1.15 to 1.70) or prior venous thromboembolism (relative risk = 8.09; 95% confidence interval, 6.07 to 10.77) had an increased risk for venous thromboembolism compared with patients without that history. The cumulative incidence of a venous thromboembolism within ninety days of surgery among patients with total hip replacement receiving pharmacological thromboprophylaxis was 1%. This information on the associated risk factors could be used to better anticipate the risk of venous thromboembolism for an individual patient.
[Show abstract] [Hide abstract] ABSTRACT: Background: Venous thromboembolism is a common postoperative complication following orthopedic surgeries, with morbid and potentially fatal consequences. Perioperative low-molecular-weight heparin (LMWH) therapy can reduce the incidence of venous thromboembolism, but may also increase the risk of bleeding complications. Current literature reflects the need to balance the improved efficacy of early initiating prophylaxis with increased risk of perioperative bleeding. The purpose of this study was to compare the effectiveness and hemorrhage related safety of preoperative versus postoperative LMWH therapy for prevention of deep venous thrombosis (DVT) and pulmonary embolism (PE) in hip fracture patients. Methods: We retrospectively evaluated 222 patients who underwent surgical treatment at Peking University People's Hospital between January 2009 and December 2010. Patients were allocated to two groups, receiving either preoperative or postoperative initiation of LMWH therapy for venous thromboembolism prophylaxis. Preoperative anticoagulation therapy was initiated 1-12 days prior to surgery (133 patients), and postoperative anticoagulation therapy was initiated 12 h after completion of surgery (89 patients). The preoperative group was further subdivided into four subgroups according to the time of initiation of therapy: 1-3 days before surgery (group A, 54 patients), 4-6 days before surgery (group B, 57 patients), 7-9 days before surgery (group C, 15 patients), and 10-12 days before surgery (group D, 7 patients). Occurrences of DVT, PE, adverse drug effects, intraoperative and postoperative bleeding were recorded, along with concentrations of preoperative and postoperative hemoglobin and length of hospital stay. The above parameters were compared between groups. Results: Among recipients of preoperative anticoagulation therapy, two patients developed postoperative PE (1.5 %), one patient developed DVT (0.75 %). In the group receiving postoperative initiation of anticoagulation therapy, one patient each developed PE and DVT (1.1 %, 1.1 %). There was no difference in the occurrence of PE and DVT between the two groups (P>0.05, Chi-square tests). We identified the incidences of major bleeding, minor bleeding, and intraspinal hematoma after spinal anesthesia, which were 0 %/0 %, 3.76 %/3.37 %, and 0 %/0 %, respectively in preoperative and postoperative anticoagulation groups. There was no significant difference in the incidence of bleeding complications between patients receiving preoperatively initiated LMWH with patients receiving postoperatively initiated LMWH. Spinal anesthesia was administered to 168 patients, with no cases of postoperative intraspinal hematoma. Conclusions: Preoperative anticoagulation therapy with LMWH may not increase intraoperative or postoperative blood loss, or the rate of intraspinal hematoma after spinal anesthesia, but also does not significantly reduce the risk of postoperative DVT or PE, compared to postoperative initiation.0Comments 0Citations
- "This study enrolled hip fracture patients who underwent surgical treatment between January 2009 and December 2010 in the Department of Orthopedics and Trauma at Peking University People's Hospital. Study subject selection criteria were determined so as to avoid the influence of known risk factors on outcomes [15, 16]. The inclusion criteria were: (1) surgical treatment for hip fracture, especially total hip arthroplasty; (2) age >40 years; (3) weight 40–100 kg; (4) no preoperative signs/ symptoms of DVT such as lower limb swelling, pain, stiffness, superficial venous congestion, or increased skin temperature; (5) no preoperative signs/symptoms of pulmonary embolism (PE) such as dyspnea, chest pain, or cough; and, (6) VTE prophylaxis with LMWH. "
[Show abstract] [Hide abstract] ABSTRACT: Introduction: Stratification of patients into different risk categories for pulmonary embolism (PE) after total joint arthroplasty (TJA) may allow clinicians to individualize venous thromboembolism prophylaxis based on an appropriate risk-benefit scale. Methods: Patients undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) as part of the American College of Surgeons National Surgical Quality Improvement Program were identified. Independent risk factors for PE within 30 days of surgery were identified and used to develop a point-scoring system to estimate the relative risk for PE. For validation, the system was tested on patients undergoing TJA at a single institution. Results: A total of 118,473 patients were identified, including 72,673 (61.3%) undergoing TKA and 45,800 (38.7%) undergoing THA. The incidence of PE within 30 days of the index arthroplasty was 0.50%. The risk factors associated with PE were age ≥70, female gender, higher body mass index (25-30 kg/m(2) and ≥30 kg/m(2)), and TKA (vs THA); anemia was protective. The point scores derived for each of these factors were as follows: anemia: -2; female: +1; body mass index 25-30 kg/m(2): +2; body mass index ≥30 kg/m(2): +3; age ≥70 years: +3; TKA: +5. The point-scoring system was then applied to 17,384 patients from a single institution. Single-institution patients categorized as low risk using the point-scoring system had a 0.44% 90-day risk for PE (95% CI = 0.29%-0.58%); medium risk, 1.51% (95% CI = 1.18%-1.84%); and high risk, 2.60% (95% CI = 2.09%-3.10%). Conclusion: This point-scoring system predicts risk for PE after TJA and may help surgeons to optimize selection of chemical prophylaxis.0Comments 0Citations
- "Among the single-institution cohort, the risk for PE varied markedly and statistically significantly between risk strata, with patients in the lowest-risk stratum having only a 0.44% 90-day risk, patients in the medium-risk stratum having a 1.51% 90-day risk, and patients in the highestrisk stratum having a 2.60% 90-day risk. The risk factors identified in the present study have all been previously identified as risk factors for PE and/or VTE . Patients with greater age have been identified as at greater risk in several studies [12,13,16]. "
[Show abstract] [Hide abstract] ABSTRACT: Risk factors for venous thromboembolism (VTE) of total joint arthroplasty (TJA) have been examined by many studies. A comprehensive systematic review of recent findings of high evidence level in this topic is needed. We conducted a PubMed search for papers published between 2003 and 2013 that provided level-I and level-II evidences on risk factors for VTE of TJA. For each potential factors examined in at least three papers, we summarize the the number of the papers and confirmed the direction of statistically significant associations, e.g. "risk factor" "protective factor" or "controversial factor". Fifty-four papers were included in the systematic review. Risk factors found to be associated with VTE of both total hip arthroplasty and total knee arthroplasty included older age, female sex, higher BMI, bilateral surgery, surgery time > 2 hours. VTE history was found as a VTE risk factor of THA but an controversial factor of TKA. Cemented fixation as compared to cementless fixation was found as a risk factor for VTE only of TKA. TKA surgery itself was confirmed as a VTE risk factor compared with THA surgery. This systematic review of high level evidences published in recent ten years identified a range of potential factors associated with VTE risk of total joint arthroplasty. These results can provide informations in this topic for doctors, patients and researchers.0Comments 3Citations
- "Six paper [26,35,37,47,53,59] examined metabolic diseases as a risk factors of VTE for THA and TKA. One paper  for THA and two papers [37,59] for TKA found metabolic syndrome with increased VTE risk. "