Risk of Venous Thromboembolism after Total Knee Arthroplasty in Patients with Rheumatoid Arthritis

Izumi, Mitsuru; Migita, Kiyoshi; Nakamura, Mashio; Jiuchi, Yuka; Sakai, Tatsuya; Yamaguchi, Takayuki; Asahara, Tomihiko; Nishino, Yuichiro; Bito, Seiji; Miyata, Shigeki; Kumagai, Kenji; Osaki, Makoto; Mawatari, Masaaki; Motokawa, Satoru

doi:10.3899/jrheum.140768

Cited by 24 publications

(24 citation statements)

References 66 publications

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“…Conversely, the higher incidence of VTE in RA than in OA patients after TKA in several previous studies may have been due to differences in sex distribution of these two diseases, with the proportion of females being higher in RA than in OA. [7,20] The meta-regression analysis performed in this study to evaluate the effect of age distribution and gender ratio on VTE incidence after TKA showed that age and gender in the RA and OA cohorts did not correlate significantly with rates of DVT and VTE.…”

Section: Discussionmentioning

confidence: 82%

“…An additional 29 studies were excluded based on unusable information and inappropriate between-group comparisons (S1 Excluded studies). Finally, six studies [7–12] were included in this meta-analysis. Dataset used in this study is given in S1 Raw data.…”

Section: Resultsmentioning

confidence: 99%

“…VTE is considered more likely to develop in patients with RA than OA, because chronic inflammatory mediators in RA are associated with prothrombotic factors and endothelial dysfunction, making these patients more susceptible to the development of atherosclerosis and thrombosis. [5,6] Nonetheless, few studies to date have directly compared the incidence of VTE after TKA in patients with RA and OA, with some comparative studies showing contradictory results [7–9]. The relative incidence of VTE after TKA in patients with RA and OA is therefore unclear.…”

Section: Introductionmentioning

confidence: 99%

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Incidence of Deep Vein Thrombosis and Venous Thromboembolism following TKA in Rheumatoid Arthritis versus Osteoarthritis: A Meta-Analysis

2016

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This meta-analysis was designed to compare the incidence of deep vein thrombosis (DVT) and venous thromboembolism (VTE) following total knee arthroplasty (TKA) in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). All studies directly comparing the post-TKA incidence of DVT and/or VTE in patients with RA and OA were included. For all comparisons, odds ratios and 95% confidence intervals (CI) were calculated for binary outcomes. Six studies were included in the meta-analysis. The pooled data showed that the combined rates of asymptomatic and symptomatic DVT did not differ significantly in the RA and OA groups (1065/222,714 [0.5%] vs. 35,983/6,959,157 [0.5%]; OR 0.77, 95% CI: 0.57 to 1.02; P = 0.07). The combined rates of asymptomatic and symptomatic DVT and pulmonary embolism (PE) after TKA were significantly lower in the RA than in the OA group (1831/225,406 [0.8%] vs. 63,953/7,018,721 [0.9%]; OR 0.76, 95% CI: 0.62 to 0.93; P = 0.008). Conclusiviely, the DVT rates after primary TKA were similar in RA and OA patients. In contrast, the incidence of VTE (DVT plus PE) after primary TKA was lower in RA than in OA patients, despite patients with RA being at theoretically higher risk of thrombi due to chronic inflammation.

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Section: Discussionmentioning

confidence: 82%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Incidence of Deep Vein Thrombosis and Venous Thromboembolism following TKA in Rheumatoid Arthritis versus Osteoarthritis: A Meta-Analysis

2016

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“…The incidence of VTE (PE+DVT) was 24.3% and 24.0% in patients with OA and RA, respectively. No significant difference in the incidence of VTE was noted between patients with RA and OA 24) . These findings contradict our hypothesis that thrombotic complications would be higher in patients with were calculated for patients receiving UFH, LMWH, fondaparinux, or only mechanical thromboprophylaxis after TKA.…”

Section: Vte and Seroconversion Rate Of Anti -Pf4/heparin Antibodies mentioning

confidence: 85%

“…Modified form of figure in the article by Sakai T, et al 19) . 24) . The study cohort was composed of 1084 OA patients and 204 patients with RA.…”

Section: Vte and Seroconversion Rate Of Anti -Pf4/heparin Antibodies mentioning

confidence: 99%

Induction of anti-PF4/heparin antibodies after arthroplasty for rheumatic diseases

Migita

Asano

Sato

et al. 2018

FJMS

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Heparin -induced thrombocytopenia (HIT) is an immune complication of heparin therapy caused by antibodies to complexes of platelet factor 4 (PF4) and heparin. These pathogenic antibodies against PF4/heparin bind and activate cellular FcγRIIa on platelets to induce a hypercoagulable state culminating in thrombosis. Recent studies indicate several conditions, including joint surgery, induce spontaneous HIT, which can occur without exposure to heparin. To determine the real -world evidences concerning the incidences of venous thromboembolism (VTE) after total joint arthroplasty for rheumatic disease, we conducted a multicenter cohort study (J -PSVT) designed to document the VTE and seroconversion rates of anti -PF4/heparin antibody in 34 Japanese National hospital organization (NHO) hospitals. J -PSVT indicated that prophylaxis with fondaparinux, not enoxaparin, reduces the risk of deep vein thrombosis in patients undergoing arthroplasty. Multivariate analysis revealed that dynamic mechanical thromboprophylaxis (intermittent plantar device) was an independent risk factor for seroconversion of anti -PF4/heparin antibodies, which was also confirmed by propensity -score matching. Seroconversion rates of anti -PF4/heparin antibodies were significantly reduced in rheumatoid arthritis (RA) patients compared with osteoarthritis (OA) patients, which may link with the findings that IgG fractions isolated from RA patients not OA patients contained PF4. Our study indicated that a unique profile of anti -PF4/heparin antibodies is induced by arthroplasty for rheumatic diseases.

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Rheumatoid Arthritis

Brown¹

2019

The Perioperative Medicine Consult Handbook

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Risk of Venous Thromboembolism after Total Knee Arthroplasty in Patients with Rheumatoid Arthritis

Abstract: Despite some differences in demographic data, patients with RA and OA have equivalent risks of VTE and bleeding following TKA.

Cited by 24 publications

References 66 publications

Incidence of Deep Vein Thrombosis and Venous Thromboembolism following TKA in Rheumatoid Arthritis versus Osteoarthritis: A Meta-Analysis

Incidence of Deep Vein Thrombosis and Venous Thromboembolism following TKA in Rheumatoid Arthritis versus Osteoarthritis: A Meta-Analysis

Induction of anti-PF4/heparin antibodies after arthroplasty for rheumatic diseases

Rheumatoid Arthritis

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