Postoperative Deep-Vein Thrombosis in Asian Patients Is Not a Rarity

Abstract

Postoperative deep-vein thrombosis (DVT) is believed to be rare in Asians. We studied 88 consecutive patients in Malaysia who had operations for fracture of the proximal femur or for total hip or knee replacement. No patient had prophylaxis against DVT; bilateral ascending venography was performed between six and ten days after operation. A total of 55 patients (62.5%) showed venographic evidence of DVT. The prevalence was greatest after total knee replacement (76.5%), less after total hip replacement (64.3%) and smallest in the fracture group (50%). One patient developed symptomatic pulmonary embolism. In contrast to other reports from Asia, we found an incidence of postoperative DVT which is similar to that reported in Western populations. This suggests that the present practice of withholding routine prophylaxis against thromboembolism in Asian patients undergoing high-risk orthopaedic procedures should be reconsidered.

Deep-vein thrombosis rates after major orthopedic surgery in Asia. An epidemiological study based on postoperative screening with centrally adjudicated bilateral venography

“…In previous Asian studies of major orthopedic surgery followed by systematic venography, the reported rates of total DVT varied widely, ranging between 0% and 64% after THR [7][8][9][10][11][12], 11% and 77% after TKR [9,[13][14][15][16][17], and 7% and 50% after HFS [8,9,18,19]. However, these studies were heterogeneous, with sample sizes ranging between 14 [9] and 244 patients [14].…”

“…However, these studies were heterogeneous, with sample sizes ranging between 14 [9] and 244 patients [14]. Although invasive, venography is the standard recommended screening method for asymptomatic DVT because it is both accurate and reliable [1].…”

Is pre-operative assessment of coagulation profile with Thrombelastography (TEG) useful in predicting venous thromboembolism (VTE) following orthopaedic surgery?

“…[1][2][3][4][5][6][7][8][9] While many studies have shown that the incidence of deep vein thrombosis (DVT) is lower in Asian patients than the Western population, 1,3,4,9 some of the recent studies from China and south east Asia have shown significant incidence of DVT in high-risk orthopaedic patients. 2,[5][6][7] In India, there are conflicting reports on the incidence of VTE. [1][2][3][4] While Bagaria 4 and Jain et al 3 reported a low incidence of DVT, Agarwala et al 2 and Dhillon 5 showed an incidence of around 60% in patients who did not have prophylaxis peri-operatively.…”

“…2,[5][6][7] In India, there are conflicting reports on the incidence of VTE. [1][2][3][4] While Bagaria 4 and Jain et al 3 reported a low incidence of DVT, Agarwala et al 2 and Dhillon 5 showed an incidence of around 60% in patients who did not have prophylaxis peri-operatively. In view of the conflicting data available, we found it necessary to have a prospective study on the incidence of VTE in high-risk orthopaedic surgery patients who were not on chemoprophylaxis at our institution.…”

A prospective randomized study on the use of nadroparin calcium in the prophylaxis of thromboembolism in Korean patients undergoing elective total hip replacement

“…Traditionally, in Asia, the risk of deep vein thrombosis (DVT) following orthopaedic surgery to the lower limb, has been considered low, and heparin or low molecular weight heparin (LMWH) is not routinely used for thromboprophylaxis [2]. Recent studies in Korea [4] and Malaysia [2] show that the incidence of DVT following surgery to the hip and knee in the absence of thromboprophylactic measures is approaching that in Western populations.…”