Incidence and natural history of deep-vein thrombosis after total knee arthroplasty

Abstract

W e have evaluated prospectively the incidence and location of deep-vein thrombosis (DVT), the risk factors for pulmonary embolism, and the natural history of thrombosis after total knee replacement (TKR) in patients who did not receive prophylactic or therapeutic treatment for DVT.We studied 227 patients who underwent primary TKR; 116 had one-stage bilateral and 111 unilateral procedures. Coagulation assays, the full blood count and blood typing tests for the serum chemical profile were undertaken in all patients on three separate occasions. Bilateral simultaneous or unilateral venograms were carried out at six or seven days after operation. Perfusion lung scanning was undertaken before and at seven or eight days after operation. Bilateral simultaneous or unilateral venograms were repeated six months after operation in all patients who had thrombi.In Thromboembolic disease is a potentially serious complication of total knee replacement (TKR). Routine postoperative venography has shown an incidence of isolated calf thrombi of between 23.8% and 60% and of proximal thrombi berween 3% and 20%.

Do anticoagulants improve survival in patients presenting with venous thromboembolism?

“…This study is at odds with that of Kim et al. [75], clearly demonstrating that untreated subclinical PDVT in the modern era can lead to fatal PE.…”

“…Furthermore, Barritt and Jordan's trial [5], despite its shortcomings, is fairly persuasive direct evidence that anticoagulants improve the outcome in more severe forms of PE. Although the studies of Johnson [84], Nielsen [6, 7] and Kim [75] are apparently at odds with this body of evidence, when viewed in the Bayesian context of the total edifice of evidence, they probably should not greatly shift our degree of belief in the precept that anticoagulants are effective in the prevention of recurrent fatal PE. And whilst the majority of PE‐related deaths occur in patients with comorbidities and/or inadequate cardiorespiratory reserve, the fact that a significant minority occur in previously fit patients [50, 90], and that recurrent fatal PE occurred in up to one‐fifth of untreated patients without cardiac disease who had clearly survived the initial event in early series [43], suggest that VTE should not be regarded as benign in unselected, previously fit patients.…”

“…In a Korean study, Kim et al. [75] venographically screened 227 patients 1 week following knee arthroplasty and found PDVT in 35 cases. These patients had received no form of prophylaxis and were not treated, and no cases of clinical PE occurred subsequently.…”

Plaučių arterijos tromboembolijos atvejis po artroskopinės kelio sąnario operacijos

“…Venų trombozę lemia 1846 m. Virchovo aprašyta triada: 1) venų vidinio dangalo pažeidimas; 2) venų stazė; 3) hiperkoaguliacija. Tokia chirurginė intervencija kaip kelio sąnario artroskopija daugiau ar mažiau veikia visas tris triados grandis [13,20]. GVT -gyvybei pavojinga komplikacija, todėl jos profilaktikai skiriama antikoaguliantų.…”

“…Tam turi įtakos operuojamų pacientų turimi rizikos veiksniai ir didelė operacijų apimtis. Todėl pagal gydymo normas tromboembolinių komplikacjų prevencijai įprasta skirti šiems pacientams mažos molekulinės masės heparino (MMMH) [1,13,14,20]. Pacientams po kelio sąnario artroskopinių operacijų tromboembolijos rizika mažesnė.…”