Incidence of deep vein thrombosis before and after total knee arthroplasty without pharmacologic prophylaxis: a 128-row multidetector CT indirect venography study

Chang, Moon Jong; Song, Min Kyu; Kyung, Min Gyu; Shin, Jae Hoon; Chang, Chong Bum; Kang, Soon Beom

doi:10.1186/s12891-018-2166-8

Cited by 30 publications

(29 citation statements)

References 26 publications

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“…Third, whether screening for preoperative DVT is needed to prevent postoperative symptomatic VTE remains to be clari ed. Chang et al reported that routine preoperative DVT evaluation is probably not necessary [22]. However, if patients scheduled for elective surgery for degenerative musculoskeletal disorders have DVT before the surgery, the risks of thrombus extension and fatal PTE could be higher.…”

Section: Discussionmentioning

confidence: 99%

Preoperative prevalence of deep vein thrombosis in patients with musculoskeletal degenerative disorders

Sato

Date

Michikawa

et al. 2021

Preprint

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Background: Although the incidence of symptomatic pulmonary thromboembolism after elective surgery for musculoskeletal degenerative disorders is comparatively low, it is extremely detrimental to both patients and health-care providers. Therefore, its prevention is mandatory. We aimed to perform a cross-sectional analysis of deep venous thrombosis (DVT) before elective surgery for degenerative musculoskeletal disorders, including total knee arthroplasty (TKA), total hip arthroplasty (THA), and spinal surgery, and identify the factors associated with the incidence of preoperative DVT.Methods: The clinical data of patients aged ≥30 years who underwent TKA or THA, and spine surgery for lumbar or cervical degenerative disorders at our institution were retrospectively collected. D-dimer levels were measured preoperatively in all the patients scheduled for surgery. For the patients with D-dimer levels ≥ 1 μg/mL or who were determined by their physicians to be at high risk of DVT, the lower extremity vein was preoperatively examined for DVT on ultrasonography.Results: Overall, we retrospectively evaluated 1236 consecutive patients, including 701 men and 535 women. Of the patients, 431 and 805 had D-dimer levels ≥ 1 and < 1 μg/mL, respectively. Of 683 patients who underwent lower extremity ultrasonography, 92 had proximal (n = 7) and distal types (n = 85) of DVT. The preoperative prevalence of DVT was 7.4%. One patient (0.08%) had the incidence of postoperative symptomatic venous thromboembolism. A multivariate analysis revealed that age ≥80 years (odds ratio [OR], 95% confidence interval [CI]: 2.8, 1.1–7.3), knee surgery (2.1, 1.1–4.0), American Society of Anesthesiologists (ASA) grade 2 (2.8, 1.2–6.8), ASA grades 3 or 4 (3.1, 1.0–9.4), and malignancy (1.9, 1.1–3.2) were significantly associated with DVT incidence.Conclusions: This is the first study to conduct a cross-sectional analysis of preoperative DVT data of patients scheduled for elective surgery for degenerative musculoskeletal disorders. Although whether screening for preoperative DVT is needed to prevent postoperative symptomatic pulmonary thromboembolism remains to be clarified, our data suggested that DVT should be noted before surgery in the patients with advanced age, knee surgery, high ASA physical status, and malignancy.

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Section: Discussionmentioning

confidence: 99%

Preoperative prevalence of deep vein thrombosis in patients with musculoskeletal degenerative disorders

Sato

Date

Michikawa

et al. 2021

Preprint

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“…Next, our study employed early DUS scan within 6 days after surgery to detect the presence of DVT. Although DUS has the advantages of being noninvasive and cost effective, with no risk of radiation, CT venography is the reference standard and widely regarded as a more sensitive method of detecting DVT [ 29 , 30 ]. The ideal timing to perform this scan, as well as the number of scans required, remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Short-duration chemoprophylaxis might reduce incidence of deep vein thrombosis in Asian patients undergoing total knee arthroplasty

Zhang

Htet

Tan

et al. 2020

Knee Surg & Relat Res

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Background Venous thromboembolism (VTE) is a serious complication that may occur after total knee arthroplasty (TKA), leading to the recommendation of routine chemoprophylaxis by international guidelines. This study aims to determine if short-duration chemoprophylaxis after TKA reduces the incidence of VTE in an Asian population. Methods A retrospective study of 316 patients who underwent unilateral primary TKA between 1 January 2011 and 31 December 2013 was conducted. All patients received mechanical prophylaxis. One hundred seventeen patients (37%) received additional chemoprophylaxis, whereas 199 patients (63%) did not. A Doppler ultrasound (DUS) of both lower limbs was conducted for all patients within 6 days after surgery (median = 3 days) to assess for both proximal and distal DVT. Chemoprophylaxis in the form of enoxaparin (low molecular weight heparin; LMWH), aspirin, or heparin was administered until patients had a normal DUS, for a median duration of 4 days. Patients were followed up clinically for a minimum of 6 months to monitor for delayed or recurrent VTE and at least 2 years for patient-reported outcome measures. Results Overall, 24 patients (7.59%) developed deep vein thrombosis (DVT): three proximal and 21 distal DVTs. Twenty-three of the 24 patients were asymptomatic. Twenty of 199 patients (10.05%) with only mechanical prophylaxis developed DVT, whereas four of 117 patients (3.42%) with additional chemoprophylaxis developed DVT. Multivariate analysis showed that chemoprophylaxis use was associated with reduced incidence of DVT (odds ratio = 0.19, p value = 0.011). Other factors associated with increased DVT incidence include female gender (odds ratio = 5.45, p value = 0.034), positive history of cancer (odds ratio = 5.14, p value = 0.044), and increased length of stay in hospital (odds ratio = 1.19, p value < 0.001). Conclusions Our study has shown that despite the low incidence of DVT in Asian patients undergoing TKA, short-duration chemoprophylaxis might be effective in reducing the incidence of DVT. However, most DVTs observed in our study were distal and may be of limited clinical significance. Further studies are needed to investigate the impact of chemoprophylaxis use on the incidence of PE and overall mortality rates among Asian patients.

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“…Early arterial problems after TKA can be treated by open thrombectomy, bypass surgery, or endovascular methods. [17][18][19] Chang et al [20] reported preoperative DVT incidence as 2.6% per patient and 1.6% per knee by computed tomography/indirect venography. Preoperative prevalence and postoperative incidence of major DVT were reported as 2.5%.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of arterial and venous abnormalities in asymptomatic patients undergoing total knee arthroplasty

Atilla¹

2019

Turk J Vasc Surg

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Objectives: This study aims to investigate the prevalence of venous and arterial diseases in asymptomatic patients undergoing total knee arthroplasty (TKA) and to evaluate possible surgery-related vascular complications. Patients and methods: The data of a total of 96 extremities of 48 vascular asymptomatic patients (9 males, 39 females; mean age 65.7±51.8 years; range, 50 to 85 years) who underwent arterial and venous bilateral Doppler ultrasound examination between October 2017 and February 2018 were retrospectively analyzed. Stenosis of the arterial and venous system thrombosis and venous insufficiency were recorded. Results: Although no significant vascular pathologies such as deep vein thrombosis or arterial occlusion were detected, minor vascular pathologies such as minimal atherosclerosis (29.2%) and venous reflux (25%) were found in patients scheduled for TKA. Conclusion: In most patients, TKA operations can be performed without a vascular comorbidity; however, even asymptomatic patients may carry vascular risks. These silent patients can be identified by simple non-invasive tests. Patients under risk are supposed to be consulted with vascular surgery before the operation and can be operated in the hospital setting where a vascular surgery unit is available. Recognizing the silent group with color Doppler ultrasound can be helpful and feasible in patients undergoing TKA to reduce complication rate and to take precautions.

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Incidence of deep vein thrombosis before and after total knee arthroplasty without pharmacologic prophylaxis: a 128-row multidetector CT indirect venography study

Cited by 30 publications

References 26 publications

Preoperative prevalence of deep vein thrombosis in patients with musculoskeletal degenerative disorders

Preoperative prevalence of deep vein thrombosis in patients with musculoskeletal degenerative disorders

Short-duration chemoprophylaxis might reduce incidence of deep vein thrombosis in Asian patients undergoing total knee arthroplasty

The prevalence of arterial and venous abnormalities in asymptomatic patients undergoing total knee arthroplasty

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