Incidence and Fate of “Symptomatic‿Venous Thromboembolism After Knee Arthroplasty Without Pharmacologic Prophylaxis in an Asian Population

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• 作者：Yong-Geun Park ; MD^a ; Chul-Won Ha ; MD^b ; ; Sung Sahn Lee ; MD^b ; Aseem Arif Shaikh ; MS^b ; Yong-Beom Park ; MD^b
• 关键词：VTE prophylaxis ; total knee arthroplasty ; symptomatic VTE ; symptomatic DVT ; symptomatic PE
• 刊名：The Journal of Arthroplasty
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：31
• 期：5
• 页码：1072-1077
• 全文大小：513 K

文摘

As the possibility of developing complications after an “asymptomatic” venous thromboembolism (VTE) after total knee arthroplasty (TKA) has been reported very low, “symptomatic” VTEs seem to be the real concern among orthopedic surgeons. Therefore, the purpose of this study was to determine the incidence of “symptomatic” VTEs and the fate of “symptomatic” VTEs after anticoagulation therapy and assess whether routine pharmacologic prophylaxis is necessary in TKA patients.

Methods

We retrospectively reviewed 2891 consecutive TKAs in 1933 patients. Graduated compression stockings and intermittent pneumatic calf compression devices were used for VTE prophylaxis. The incidence of symptomatic VTE was investigated until 6 months postoperatively. Patients with VTE underwent anticoagulation therapy and followed up to evaluate range of motion, knee society score, Western Ontario and McMaster Universities index scores, and the presence of any complications (mean follow-up period, 3.6 years).

Results

Fifty-three (1.83%) of the 2891 TKAs had suggestive symptoms and/or sign of VTE. Of these 53 cases, 26 (0.90%) were diagnosed as symptomatic VTE, which comprised 10 (0.35%) symptomatic deep venous thromboses, 11 (0.38%) symptomatic pulmonary embolisms (PEs), 5 (0.17%) symptomatic deep venous thromboses combined with PEs, and no fatal PE. There was no significant difference in range of motion, knee society score, and Western Ontario and McMaster Universities index scores between the groups with or without symptomatic VTE. When treated properly after the diagnosis of symptomatic VTE, no specific complications were identified.

Conclusion

Symptomatic VTEs are rare in patients who undergo TKAs with mechanical prophylaxis only. Patients with symptomatic VTEs after TKA can be treated without significant sequelae once they are properly treated with anticoagulation after the diagnosis.