Prevalence and Risk Factors of Thromboembolism After Joint Arthroplasty Without Chemical Thromboprophylaxis in an Asian Population

Won, Man-Hee; Lee, Gye-Wang; Tongjoo, Lee; Moon, Kyoung-Ho

doi:10.1016/j.arth.2010.11.005

Cited by 22 publications

(31 citation statements)

References 16 publications

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“…Recent Asian studies showed that the incidence of all DVT was 8%-49% in patients not receiving chemoprophylaxis ( 15 , 16 , 17 ). The relatively low incidence of VTE in Asian studies has prompted the disagreement on routine chemoprophylaxis after HKRA ( 18 19 20 ). The low incidence of VTE in Asians is known to be attributed to the low incidence of obesity and hyperlipidemia as well as the scarcity of some genetic factors ( 4 19 ).…”

Section: Discussionmentioning

confidence: 99%

Venous Thromboembolism Following Hip and Knee Replacement Arthroplasty in Korea: A Nationwide Study Based on Claims Registry

et al. 2016

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The aim of this study was to examine the incidence and trends of clinically relevant venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) after hip and knee replacement arthroplasty (HKRA) in Korea. Between January 1 and December 31, 2010, 22,127 hip replacement arthroplasty (HRA) patients and 52,882 knee replacement arthroplasty (KRA) patients were enrolled in the analysis using the administrative claims database of the Health Insurance Review and Assessment Service (HIRA). All available parameters including procedure history and clinically relevant VTE during the 90 days after HKRA were identified based on diagnostic and electronic data interchange (EDI) codes. The overall incidence of VTE, DVT, and PE during the 90 days was 3.9% (n=853), 2.7% (n=597), and 1.5% (n=327) after HRA, while the incidence was 3.8% (n=1,990), 3.2% (n=1,699), and 0.7% (n=355) after KRA. The incidence of VTE after HKRA was significantly higher in patients who had previous VTE history (odds ratio [OR], 10.8 after HRA, OR, 8.5 after KRA), chronic heart failure (2.1, 1.3), arrhythmia (1.8, 1.7), and atrial fibrillation (3.4, 2.1) than in patients who did not. The VTE incidence in patients with chemoprophylaxis was higher than that in patients without chemoprophylaxis. The incidence of VTEs revealed in this retrospective review was not low compared with the results of the studies targeting other Asian or Caucasian populations. It may warrant routine prevention including employment of chemoprophylaxis. However, the limitation of the reviewed data mandates large scale prospective investigation to affirm this observation.

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Section: Discussionmentioning

confidence: 99%

Venous Thromboembolism Following Hip and Knee Replacement Arthroplasty in Korea: A Nationwide Study Based on Claims Registry

et al. 2016

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“…Ethnicity is one of the major factors affecting the incidence of VTE in patients who have undergone hip or knee arthroplasty . Although the VTE incidence in Asian populations has been reported to be lower than that in Caucasian populations, the rapid increase in the incidence of VTE among Asian populations was recently reported …”

Section: Introductionmentioning

confidence: 99%

“…Until now, the NICE did not recommend the use of aspirin for VTE prophylaxis in major orthopedic surgery patients. However, the use of aspirin as a pharmacological prophylactic agent after total hip replacement has increased . Previous studies have reported controversial results on the effect of aspirin as a VTE prophylaxis compared with other antithrombotic agents .…”

Section: Introductionmentioning

confidence: 99%

“…4 Although the VTE incidence in Asian populations has been reported to be lower than that in Caucasian populations, the rapid increase in the incidence of VTE among Asian populations was recently reported. 4,5 However, there are still controversies regarding the necessity of routine pharmacological thromboprophylaxis and the most beneficial agent that provides effective prophylaxis against VTE while minimizing bleeding events. Professional organizations such as National Institute for Health and Care Excellence (NICE), American College of Chest Physicians (ACCP), and American Academy of Orthopedic Surgeons (AAOS) have issued guidelines with different recommendations.…”

mentioning

confidence: 99%

“…However, the use of aspirin as a pharmacological prophylactic agent after total hip replacement has increased. 5,6 Previous studies have reported controversial results on the effect of aspirin as a VTE prophylaxis compared with other antithrombotic agents. 7,8 Four randomized controlled trials that directly compared the effect of aspirin and low-molecular-weight heparins (LMWHs) showed that DVT rates were lower with aspirin.…”

mentioning

confidence: 99%

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Clinical outcomes and risk factors of thromboprophylaxis with rivaroxaban versus aspirin in patients undergoing hip arthroplasty in low‐incidence population: A nationwide study in Korea

Kim

Lee

Park

et al. 2019

Pharmacoepidemiology and Drug

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Purpose We aimed to evaluate the efficacy and safety of rivaroxaban in thromboprophylaxis compared with those of aspirin in real‐world patients who underwent hip arthroplasty using nationwide claims data. Methods Patients aged more than or equal to 18 years with at least one hip arthroplasty including total and partial hip replacements and hip replacement revisions during July 2009 to June 2013 were identified from the Health Insurance Review and Assessment (HIRA) database. The study outcome was incidence rate of thromboembolic events and anticoagulation‐related major bleeding within 90 days of hip arthroplasty. Results The incidence of overall venous thromboembolism (VTE) within 90‐day postsurgery was significantly higher in the aspirin cohort than it was in the rivaroxaban cohorts. Bleeding events associated with pharmacological thromboprophylaxis in patients who received rivaroxaban were not significantly different from that in aspirin‐treated patients. In aspirin cohorts, 65.7% of patients received less than 3‐week treatment while about half received a less than 14‐day treatment, and 31.7% received more than 3‐week treatment in the rivaroxaban cohort. Conclusions This study demonstrates that rivaroxaban was more effective in preventing VTE following hip arthroplasty without raising bleeding risks in clinical settings. Age more than or equal to 80 years, women, and a history of thromboembolism were the risk factors of VTE incidence.

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The incidence of symptomatic in-hospital VTEs in Asian patients undergoing joint arthroplasty was low: a prospective, multicenter, 17,660-patient-enrolled cohort study

Zeng

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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Purpose The aim of this study was to determine the real incidence of symptomatic in‐hospital venous thromboembolism (VTE) and identify risk factors for VTEs in Asian patients undergoing total hip (THA) and total knee arthroplasty (TKA). Methods A total of 17,660 patients (20,078 hips and knees) undergoing THA and TKA at 78 hospitals were enrolled. The composite incidence of symptomatic in‐hospital DVT and PE was identified as the primary effectiveness outcomes. The primary safety outcomes were the incidences of postoperative complications, especially for major or minor bleeding. Secondary analyses were assessed to identify the risk factors for postoperative VTE. Results The overall rates of symptomatic in‐hospital DVT in patients undergoing THA and TKA were 0.21% (19/9022) and 0.36% (31/8638), respectively. Symptomatic PE was confirmed in one TKA patient. Safety analysis showed that the incidence of bleeding during hospital stays in patients undergoing THA and TKA was 0.10% (18/17,660). Increased VTE risks were associated with old age, high BMI index, hypertension, cerebrovascular disease, history of venous thromboembolism and no medical prophylaxis usage. Conclusions The incidence of symptomatic VTEs in Asian regions was low compared with that reported in studies targeting Western populations. Approximately 1 in 500 patients undergoing THA and approximately 1 in 300 patients undergoing TKA developed symptomatic VTEs prior to hospital discharge. Old age, high BMI, history of venous thromboembolism, hypertension, cerebrovascular disease, and no medication prophylaxis were risk factors identified in this study. Level of evidence Prospective cohort study; Level 2.

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Prevalence and Risk Factors of Thromboembolism After Joint Arthroplasty Without Chemical Thromboprophylaxis in an Asian Population

Cited by 22 publications

References 16 publications

Venous Thromboembolism Following Hip and Knee Replacement Arthroplasty in Korea: A Nationwide Study Based on Claims Registry

Venous Thromboembolism Following Hip and Knee Replacement Arthroplasty in Korea: A Nationwide Study Based on Claims Registry

Clinical outcomes and risk factors of thromboprophylaxis with rivaroxaban versus aspirin in patients undergoing hip arthroplasty in low‐incidence population: A nationwide study in Korea

The incidence of symptomatic in-hospital VTEs in Asian patients undergoing joint arthroplasty was low: a prospective, multicenter, 17,660-patient-enrolled cohort study

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