Incidence rates for thromboembolic, bleeding and hepatic outcomes in patients undergoing hip or knee replacement surgery

Lanes, S.; Fraeman, Kathy; Meyers, Art; Ives, Jennifer Wood; Huang, Han-Yao

doi:10.1111/j.1538-7836.2010.04155.x

Cited by 11 publications

(10 citation statements)

References 28 publications

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“…Dawson et al and Fisher et al found perioperative incidences of 39% and 29%, respectively, in the elderly population 7, 9 . Few studies have simultaneously investigated the incidence of both thrombotic and bleeding complications in orthopedic surgery, and in those studies, the majority of data were ascertained from coding alone without any biomarker data 13, 19–22 .…”

Section: Discussionmentioning

confidence: 99%

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Thrombotic and bleeding complications after orthopedic surgery

Oberweis

Nukala

Rosenberg

et al. 2013

American Heart Journal

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Background Thrombotic and bleeding complications are major concerns during orthopedic surgery. Given the frequency of orthopedic surgical procedures and the limited data in the literature, we sought to investigate the incidence and risk factors for thrombotic (myocardial necrosis and infarction) and bleeding events in patients undergoing orthopedic surgery. Methods and Results We performed a retrospective cohort analysis of 3,082 consecutive subjects ≥ 21 years of age undergoing hip, knee, or spine surgery between November 1, 2008, and December 31, 2009. Patient characteristics were ascertained using ICD-9 diagnosis coding and retrospective review of medical records, and laboratory/blood bank databases. In-hospital outcomes included myocardial necrosis (elevated troponin), major bleeding, coded myocardial infarction (MI), and coded hemorrhage as defined by ICD-9 coding. Of the 3,082 subjects, mean age was 60.8 ± 13.3 years and 59% were female. Myocardial necrosis, coded MI, major bleeding, and coded hemorrhage occurred in 179 (5.8%), 20 (0.7%), 165 (5.4%), and 26 (0.8%) subjects, respectively. Increasing age (P<0.001), CAD (P<0.001), cancer (P=0.004), and chronic kidney disease (P=0.01) were independent predictors of myocardial necrosis, while procedure type (P<0.001), cancer (P<0.001), female sex (P<0.001), CAD (P<0.001), and COPD (P=0.01) were independent predictors of major bleeding. Conclusion There is a delicate balance between thrombotic and bleeding events in the perioperative period following orthopedic surgery. Perioperative risk of both thrombosis and bleeding deserve careful attention in preoperative evaluation and future prospective studies aimed at attenuating this risk are warranted.

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Section: Discussionmentioning

confidence: 99%

“…Subjects with established CAD are at increased risk for both perioperative thrombotic and bleeding complications 4, 13 , and the potential benefit of antiplatelet therapy to decrease thrombotic events must be weighed against increased risk of bleeding during the perioperative period.…”

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Thrombotic and bleeding complications after orthopedic surgery

Oberweis

Nukala

Rosenberg

et al. 2013

American Heart Journal

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“…Previous epidemiological studies have not compared rates with that in control subjects, and the majority took only perioperative periods into consideration. 3,[5][6][7][8] For example, Bateman and colleagues reported a perioperative stroke rate of 0.2% among 201 235 American THR patients. 3 In line with our findings, the two studies that looked beyond discharge as well, showed a 1-year incidence rate as high as 1.5% (compared with 1.4% in our study).…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

“…4 Epidemiological studies demonstrated perioperative stroke incidence rates as high as 0.6%. 3,[5][6][7][8] This complication has become of particular interest, given the fact that THRs are performed in large numbers (≈1 million annually worldwide) and the surgery is offered to older patients more often.…”

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Timing of Stroke in Patients Undergoing Total Hip Replacement and Matched Controls

Lalmohamed

Vestergaard

Cooper

et al. 2012

Stroke

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Although incidence rates of perioperative stroke following THR have been described reasonably well, the rates have not been compared with control subjects who did not have surgery. Furthermore, the timing of these events has not been thoroughly evaluated, in particular the period after THR discharge. None of the previous studies were able to evaluate effect modification by comorbidities and drug use. This is of particular interest, as THR patients widely use pain relievers, which have been associated with both an increased and decreased risk of stroke. [11][12][13] Other drugs that may be associated with a decreased or increased risk of stroke include antiplatelet drugs, anticoagulants, statins, thiazide diuretics, estrogen-containing drugs, selective serotonin reuptake inhibitors, and antipsychotics. 1,[14][15][16][17][18] Its use in THR patients in relation with perioperative stroke, however, remains unknown.The objectives of this study were to evaluate timing of stroke after THR compared with matched control subjects Background and Purpose-Stroke is a potentially fatal complication of total hip replacements (THR). However, timing of stroke in THR patients compared with matched controls and influence of drug use remain unknown. The objective of this study was to determine timing of stroke in patients with THR compared with matched control subjects. Methods-A nationwide cohort study was conducted within the Danish registers (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007). Included patients were those with a primary THR in the study period (n=66 583) and were matched by age, sex, and region to three referent subjects without THR or total knee replacements. Time-dependent Cox models were used to derive hazard ratios and were adjusted for disease history and drug use. Results-A 4.7-fold increased risk of ischemic stroke (adjusted hazard ratio, 4.69; 95% CI, 3.12-7.06), and a 4.4-fold increased risk of hemorrhagic stroke (adjusted hazard ratio, 4.40; 95% CI, 2.01-9.62) were found within 2 weeks following THR, compared with matched controls. The risk remained elevated during the first 6 postoperative weeks for ischemic stroke, and the first 12 weeks for hemorrhagic stroke. Outpatient antiplatelet drug use lowered the 6-week hazard ratios for ischemic stroke by 70%, although not affecting risk of hemorrhagic stroke. Conclusions-This study shows, that THR patients have a 4.7-fold increased risk of ischemic stroke, and a 4.4-fold increased risk of hemorrhagic stroke during the first 2 weeks postsurgery. Risk assessment of stroke in individual patients undergoing THR (ie, evaluate other risk factors for stroke) should be considered during the first 6 to 12 weeks. (Stroke. 2012;43:3225-3229.)

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“…It is increasingly realized that venous and arterial thrombosis share multiple risk factors [3], including precipitation by acute infections, trauma, surgery [4] or oral estrogens [5]. After coronary heart disease (CHD) and stroke, VTE is the commonest cause of cardiovascular death and disability.…”

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Epidemiology of venous thromboembolism: the need for large (including prospective) studies and meta‐analyses

Lowe

2012

Journal of Thrombosis and Haemostasis

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To cite this article: Lowe GDO. Epidemiology of venous thromboembolism: the need for large (including prospective) studies and meta-analyses.J Thromb Haemost 2012; 10: 2186-8.See also Rosendaal FR. Etiology of venous thrombosis: the need for small original studies. This issue, pp 2189-90 and El-Galaly TC, Kristensen SR, Overvad K, Steffensen R, Tjønneland A, Severinsen MT. Interaction between blood type, smoking and factor V Leiden mutation and risk of venous thromboembolism: a Danish case-cohort study. This issue, pp 2191-3.In this issue of the Journal, El-Galaly et al.[1] report on the interactions of two genetic risk factors (non-O blood group and factor V Leiden) for venous thromboembolism (VTE) and two lifestyle risk factors (tobacco-smoking and obesity), using data from a large national prospective study in Denmark. They observed positive interactions of non-O blood group with factor V Leiden, and with heavy smoking, but not with severe obesity. This report extends our knowledge on interactive risk factors for VTE, and highlights the need for further large (including prospective) studies and meta-analyses, to provide scientists, clinicians and their patients with reliable information.It is generally accepted that, like arterial thrombosis, VTE is a multifactorial disease, to which many genetic and environmental factors contribute about equally [2]. These risk factors interact: about half of acute VTE events are precipitated by recognized acute environmental exposures such as trauma, surgery, other illnesses such as infections, or drugs such as oral estrogens. At these times, such prothrombotic interactions are postulated to exceed a threshold at which thrombosis occurs [2].It is increasingly realized that venous and arterial thrombosis share multiple risk factors [3], including precipitation by acute infections, trauma, surgery [4] or oral estrogens [5]. After coronary heart disease (CHD) and stroke, VTE is the commonest cause of cardiovascular death and disability. It is therefore timely and appropriate to compare the historical epidemiological approaches to establishing reliable estimates of the contributions of postulated risk factors (and their interactions) to VTE and to arterial thrombosis (CHD and stroke).To address the epidemic of CHD, which emerged in developed countries in the second half of the 20th century, several prospective studies of risk factors were established in North America, Europe and Australasia. Within 20 years, interactive risk factors, including age, male sex, tobaccosmoking, blood pressure and serum cholesterol, were identified in studies such as the Framingham Study, and observed to be common to stroke and peripheral arterial disease, as well as CHD [6]. Possible chance differences between findings in individual studies were addressed by systematic reviews and meta-analyses of individual participant data (IPD) by the Prospective Studies Collaboration [7,8]. Following the identification of random measurement error in estimates of an individualÕs usual levels of risk factors as a...

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Incidence rates for thromboembolic, bleeding and hepatic outcomes in patients undergoing hip or knee replacement surgery

Cited by 11 publications

References 28 publications

Thrombotic and bleeding complications after orthopedic surgery

Thrombotic and bleeding complications after orthopedic surgery

Timing of Stroke in Patients Undergoing Total Hip Replacement and Matched Controls

Epidemiology of venous thromboembolism: the need for large (including prospective) studies and meta‐analyses

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