Epidemiology of post-operative venous thromboembolismin asian countries

Abstract

Background: In Asia, the prevalence of postoperative venous thromboembolism (VTE) is traditionally thought to be low and the routine use of thromboprophylaxis remains controversial. Methods: We performed an exhaustive literature search for published studies on VTE in Asia. Predefined data were extracted from individual studies: country involved, number of patients, type of patient population, type, duration and dose regimens of treatments, if any, method used to detect deep-vein thrombosis (DVT) and pulmonary embolism (PE), and duration of follow-up. The main endpoints were the incidences of systematically detected DVT, and symptomatic DVT or PE. Overall adjusted percentages and 95% confidence intervals (CI) were calculated. Results: In clinical studies in patients not receiving thromboprophylaxis, the adjusted incidence of total DVT was 13% (95% CI: 10% to 16%) in general surgery, 16% (95% CI: 13% to 20%) after total hip replacement, 50% (95% CI: 44% to 55%) after total knee replacement and 18% (95% CI: 12% to 24%) in hip fracture surgery. The adjusted incidence of PE was 1% (95% CI: 0% to 2%) in general surgery and 1.4% (95% CI: 1% to 3%) after total hip replacement. In autopsy studies, the incidence of fatal PE ranged from 0.2% to 6.0%, increasing consistently over a period of 30 years in Japan and Hong Kong. Conclusions: Post-operative VTE is frequent in Asian general and orthopedic surgery patients and the incidence of autopsy-proven fatal PE is increasing over time. The use of routine prophylaxis in Asian patients undergoing highrisk surgical procedures should be considered.

Venous thromboembolism and ethnicity

“…They determined rates of objectively documented VTE (both symptomatic and asymptomatic) in patients not receiving thromboprophylaxis from studies undertaken in Hong Kong, Korea, Japan, Malaysia, Thailand and Singapore. The overall adjusted rate of VTE following general surgery was 13%, 16% after total hip and 50% after total knee replacement, and 18% following hip fracture surgery (Leizorovicz et al, 2004). Further prospective studies in post-operative patients have since demonstrated VTE rates (both symptomatic and asymptomatic) in Asians to be significant and comparable with that seen in Caucasian populations (see Table IV) (Geerts et al, 2004;Leizorovicz et al, 2005;Piovella et al, 2005;Sakon et al, 2006).…”

“…These reports of low incidence of post-operative VTE may have arisen at least in part due to under-diagnosis and have subsequently led to the infrequent use of surgical thromboprophylaxis. A comprehensive review and analysis of published data on post-operative VTE in Asians demonstrated that VTE is not rare (Leizorovicz et al, 2004). They determined rates of objectively documented VTE (both symptomatic and asymptomatic) in patients not receiving thromboprophylaxis from studies undertaken in Hong Kong, Korea, Japan, Malaysia, Thailand and Singapore.…”

Combination of enoxaparin and low-dose aspirin for thromboprophylaxis in selective patients after primary total joint arthroplasty in a Taiwanese population

“…15,16 For example, not all TJA patients in Asian countries receive VTE prophylaxis. [17][18][19] Although this practice may deviate from the American Academy of Orthopaedic Surgeon and ACCP guidelines, several studies have supported this, and this practice is based on evidence that Asian populations have lower overall and postoperative VTE rates. 2,3,9,[20][21][22] Therefore, the VTE criteria for prophylaxis applied in this study were based on known VTE risk factors, 23 including high BMI, varicose veins, history of VTE; and later included patients undergoing a bilateral TJA procedure.…”

Prediction model of deep vein thrombosis risk after lower extremity orthopedic surgery

“…Considering the basic incidence rate that nearly one million adults undergo LEOS each year in the United States [ 5 ], it is understandable to discover the corresponding high hospitalizations up to 0.6 million due to deep vein thrombosis (DVT) and pulmonary embolism (PE) [ 6 ], and asymptomatic DVT incidence of 36%–84 % after LEOS without pharmacological thromboprophylaxis [ 7 ]. However, different from those in western countries, only 17%–43 % incidence of asymptomatic DVT could be observed in Asia patients [ 8 ], while the incidence of registered DVT after LEOS was under 0.3 % in Korea [ 9 ]. A recent prospective multicenter study indicated that the incidence of hospital DVT was 0.9 % in China [ 10 ].…”