Incidence of Deep Vein Thrombosis and Pulmonary Embolus Following Periacetabular Osteotomy

Zaltz, Ira; Beaulé, Paul E.; Clohisy, John C.; Schoenecker, Perry L.; Sucato, Daniel J.; Podeszwa, David A.; Sierra, Rafael J.; Trousdale, Robert T.; Kim, Young Jo; Millis, Michael B.

doi:10.2106/jbjs.j.01769

Cited by 36 publications

(24 citation statements)

References 23 publications

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“…Specifically, results from a multicenter database showed four cases of PE and seven cases of DVT for a crude incidence of 9.4 per 1000 procedures [17]. Across the six centers, various prophylaxis strategies were used.…”

Section: Discussionmentioning

confidence: 99%

“…Across the six centers, various prophylaxis strategies were used. The data from Zaltz et al [17] suggest that the risk of symptomatic DVT is low but proper studies with effective screening methods are needed to fully evaluate this risk.…”

Section: Discussionmentioning

confidence: 99%

“…A concern associated with antifibrinolytic agents such as TXA is the possible increased risk of thrombosis, but reviews and multiple studies on this topic have identified no increased risk [1,2,4,11]. After PAO, the incidence of symptomatic venous thromboembolism, including symptomatic deep vein thrombosis (DVT) and symptomatic pulmonary embolism (PE), is low [17].…”

Section: Clinical Orthopaedics and Related Researchmentioning

confidence: 99%

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Does Tranexamic Acid Reduce Blood Loss and Transfusion Requirements Associated With the Periacetabular Osteotomy?

Wingerter

Keith

Schoenecker

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Tranexamic acid (TXA) has shown safety and efficacy in reducing blood loss associated with various surgical procedures. However, to our knowledge there are no studies evaluating the effect of TXA on blood loss and transfusion requirements associated with periacetabular osteotomy (PAO). Questions/purposes The main purpose of this study is to determine whether TXA reduces blood loss and transfusion use in patients undergoing PAO for symptomatic acetabular dysplasia. Our secondary purpose was to compare the frequency of symptomatic thromboembolic events between patients undergoing surgery with and without TXA. Methods A consecutive series of 100 periacetabular osteotomies performed by one surgeon was reviewed to compare the groups immediately before and after implementation of routine use of tranexamic acid (two retrospective cohorts). TXA dosing followed an established protocol with a standard dose of 1 g infused intravenously during 10 minutes before skin incision and an additional 1 g intravenously at wound closure. Outcome measures include total estimated blood loss perioperatively and transfusion requirements. Total estimated blood loss was calculated using a formula built from the National Surgical Quality Improvement Program data regarding surgical blood loss. Results The mean perioperative total estimated blood loss was less in the patients receiving TXA compared with blood loss in patients who did not receive TXA (706 mL versus 1021 mL; p \ 0.001; 95% CI, À495 to À134). Twenty-six (52%) of the 50 patients who did not receive TXA had postoperative blood transfusions compared with 15 (30%) of 50 who received TXA (odds ratio, 0.395; 95% CI, p = 0.0414). No symptomatic deep vein thromboses or symptomatic pulmonary emboli were identified in either group. Conclusions TXA reduces estimated blood loss and the frequency of transfusions in patients undergoing PAO for treatment of symptomatic acetabular dysplasia. Future prospective studies should confirm our findings to determine whether patients undergoing PAO should receive routine perioperative TXA. Level of Evidence Level III, therapeutic study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Clinical Orthopaedics and Related Researchmentioning

confidence: 99%

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Does Tranexamic Acid Reduce Blood Loss and Transfusion Requirements Associated With the Periacetabular Osteotomy?

Wingerter

Keith

Schoenecker

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Thus, albeit with no supporting evidence, pharmacological prophylaxis would be a wise precaution [1, 26, 27]. …”

Section: Prophylaxis In Orthopaedic and Trauma Surgerymentioning

confidence: 99%

“…Pelvic and acetabulum trauma presents a high risk of thromboembolism in both unstable fractures requiring surgery and stable fractures, due to the need for bed confinement [26, 27, 43–45]. In cases of multiple fractures, the high risk of VTE is not usually associated with an increase in haemorrhagic risk.…”

Section: Prophylaxis In Orthopaedic and Trauma Surgerymentioning

confidence: 99%

II Italian intersociety consensus statement on antithrombotic prophylaxis in orthopaedics and traumatology

Randelli

Romanini²,

Biggi³

et al. 2012

J Orthopaed Traumatol

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Pharmacological prophylaxis for preventing venous thromboembolism (VTE) is a worldwide established procedure in hip and knee replacement surgery, as well as in the treatment of femoral neck fractures, but few data exist in other fields of orthopaedics and traumatology. Thus, no guidelines or recommendations are available in the literature except for a limited number of weak statements about knee arthroscopy and lower limb fractures. In any case, none of them are a multidisciplinary effort as the one here presented. The Italian Society for Studies on Haemostasis and Thrombosis (SISET), the Italian Society of Orthopaedics and Traumatology (SIOT), the Association of Orthopaedic Traumatology of Italian Hospitals (OTODI), together with the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) and the Italian Society of General Medicine (SIMG) have set down easy and quick suggestions for VTE prophylaxis in a number of surgical conditions for which only scarce evidence is available. This inter-society consensus statement aims at simplifying the approach to VTE prophylaxis in the single patient with the goal to improve its clinical application.

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Pelvic Osteotomy for Young Adult Hip Disease

Munro

Graydon

Garbuz

2013

The Young Adult Hip in Sport

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Incidence of Deep Vein Thrombosis and Pulmonary Embolus Following Periacetabular Osteotomy

Abstract: The risk from chemoprophylaxis and the development of hematoma may be greater than the risk of clinically important venous thromboembolism in patients undergoing periacetabular osteotomy.

Cited by 36 publications

References 23 publications

Does Tranexamic Acid Reduce Blood Loss and Transfusion Requirements Associated With the Periacetabular Osteotomy?

Does Tranexamic Acid Reduce Blood Loss and Transfusion Requirements Associated With the Periacetabular Osteotomy?

II Italian intersociety consensus statement on antithrombotic prophylaxis in orthopaedics and traumatology

Pelvic Osteotomy for Young Adult Hip Disease

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