Systematic review and meta-analysis on the rate of postoperative venous thromboembolism in orthopaedic surgery in Asian patients without thromboprophylaxis
Vascular Unit, Department of Surgery, Faculty of Medicine, Vajira Hospital, University of Bangkok Metropolitan, Bangkok, Thailand. British Journal of Surgery
(Impact Factor: 5.54).
10/2011; 98(10):1356-64. DOI: 10.1002/bjs.7589
Postoperative venous thromboembolism (VTE) is a common life-threatening complication after surgery. This review analysed the rate and mortality of VTE after orthopaedic surgery in Asia.
Inclusion criteria were: prospective study; deep vein thrombosis (DVT) diagnosed by venography or ultrasonography; hip fracture surgery (HFS), total hip arthroplasty (THA) or total knee arthroplasty (TKA); and no thromboprophylaxis. The pooled proportion was back-calculated by Freeman-Tukey variant transformation, using a random-effects model.
Twenty-two studies (total population 2454) published from 1979 to 2009 were included. Using venography, the pooled rates of all-site, proximal, distal and isolated distal DVT were 31·7, 8·9, 22·5 and 18·8 per cent respectively. With duplex ultrasonography, the respective rates were 9·4, 5·9, 5·9 and 5·8 per cent. After THA or HFS, using venography, the pooled rates of all-site and proximal DVT were 25·8 and 9·6 per cent; with ultrasonography, the respective rates were 10·8 and 7·2 per cent. In TKA groups, using venography, the pooled rates of all-site and proximal DVT were 42·5 and 8·7 per cent; with ultrasonography, the respective rates were 9·5 and 5·2 per cent. The overall pooled rates of symptomatic DVT and symptomatic pulmonary embolism (PE) were 4·5 and 0·6 per cent. No patient died from PE (pooled rate 0·2 per cent).
None of these Asian patients undergoing orthopaedic surgery died from VTE. Pooled rates of proximal and symptomatic DVT were lower than in Western reports.
Available from: Kang-Il Kim
- "An estimated incidence across various countries in East Asia is shown in Table 110-21). Asian patients have traditionally been considered to have a low prevalence of DVT and PE9). Moreover, a recent meta-analysis has reported that the incidence of VTE after knee arthropalsty without chemoprophylaxis was still low in Asians and there was no trend in changes of the incidence over time22). "
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ABSTRACT: Postoperative venous thromboembolism is one of the most serious complications following total joint arthroplasty. Pharmacological and mechanical prophylaxis methods are used to reduce the risk of postoperative symptomatic deep vein thrombosis and pulmonary embolism. Use of pharmacological prophylaxis requires a fine balance between the efficacy of the drug in preventing deep vein thrombosis and the adverse effects associated with the use of these drugs. In regions with a low prevalence of deep vein thrombosis such as Korea, there might be a question whether the benefits of using pharmacological prophylaxis outweigh the risks involved. The current article reviews the need for thromboprophylaxis, guidelines, problems with the guidelines, pharmacological prophylaxis use, and the current scenario of deep vein thrombosis, and discusses whether the use of pharmacological prophylaxis should be mandatory in low incidence populations.
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ABSTRACT: Despite advances in the management of venous thromboembolism (VTE), treatment of many patients worldwide, especially in Asia, remains inadequate and/or discordant with prevailing guidelines. Although epidemiological studies consistently report lower incidences of VTE in Asians than Caucasians, VTE rates in Asia have probably been gravely underestimated, partly due to comparatively lesser ascertainment. It is becoming evident that Asians are at much higher risk of VTE than was hitherto supposed. Nevertheless, VTE risk-assessment is not routine in Asia and thromboprophylaxis rates are much lower than in Western nations. It is important to base decisions about anticoagulation on individual circumstances and weigh the potential benefits and risks. The conventional VTE management paradigm is not ideal. New oral anticoagulants offer advantages over current modalities that may help to streamline patient care and reduce healthcare costs. Initially, they will be mainly used in uncomplicated cases and, in the absence of clear differences in efficacy or safety, convenience, tolerability/adherence and cost will determine treatment choice. There is clear scope to improve VTE prevention and treatment in Asia. Key priorities are raising awareness of best practice and properly implementing guidelines. Uncertainty about the burden of VTE and concern about bleeding are barriers. High-quality Asian epidemiological data are needed to guide healthcare policy and evidence-based practice. More data on the occurrence and management of bleeding complications in Asian patients are also required. Meanwhile, physicians should remain vigilant and strive to act early, decisively and appropriately to diagnose and treat VTE, particularly in patients at high risk.
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