Screening for Deep Vein Thrombosis After Periacetabular Osteotomy in Adult Patients: Is It Necessary?

Polkowski, Gregory G.; Duncan, Stephen T.; Bloemke, Adam D.; Schoenecker, Perry L.; Clohisy, John C.

doi:10.1007/s11999-014-3614-x

Cited by 11 publications

(10 citation statements)

References 14 publications

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“…They found a 1.3% rate of deep venous thrombosis on routine screening of 136 hips, with a mean patient age of 30 years. 27 In adolescents undergoing periacetabular osteotomy, Thawrani et al 28 found no cases of symptomatic deep venous thrombosis in a cohort of 83 patients. The current study reports a thromboembolic disease rate of 2 of 75 (2.67%) in patients receiving aspirin twice daily as well as mechanical prophylaxis after undergoing Bernese periacetabular osteotomy with intravenous tranexamic acid.…”

Section: Discussionmentioning

confidence: 97%

“…Zaltz et al 6 reported on the crude incidence of deep venous thrombosis and pulmonary embolism in adult and adolescent patients undergoing Bernese periacetabular osteotomy and found a low rate of 9.4 of 1000 with variable anticoagulation protocols. Polkowski et al 27 studied the frequency of thromboembolic disease in adult patients undergoing periacetabular osteotomy and receiving aspirin twice daily as well as mechanical prophylaxis by assessing an ultrasound at 1 week postoperatively. They found a 1.3% rate of deep venous thrombosis on routine screening of 136 hips, with a mean patient age of 30 years.…”

Section: Discussionmentioning

confidence: 99%

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Intravenous Tranexamic Acid Decreases Allogeneic Transfusion Requirements in Periacetabular Osteotomy

Bryan¹,

Sanders²,

Trousdale³

et al. 2016

Orthopedics

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Bernese (Ganz) periacetabular osteotomy is associated with significant blood loss and the need for perioperative transfusion. Tranexamic acid decreases blood loss and minimizes transfusion rates in total joint arthroplasty. However, no reports have described its use in patients undergoing Bernese periacetabular osteotomy. This study reports the use of intravenous tranexamic acid in these patients. The study included 137 patients (150 hips) who underwent isolated periacetabular osteotomy at a single institution between 2003 and 2014. Of these, 68 patients (75 hips) received intravenous tranexamic acid 1 g at the time of incision and 1 g at the time of closure. A group of 69 patients (75 hips) served as control subjects who underwent periacetabular osteotomy without administration of intravenous tranexamic acid. Thromboembolic disease was defined as deep venous thrombosis or pulmonary embolism occurring within 6 weeks of surgery. Outcomes measured included transfusion requirements, pre- and postoperative hemoglobin values, operative times, and thromboembolic disease rates. Aspirin was used as the thromboembolic prophylactic regimen in 95% of patients. The rate of allogeneic transfusion was 0 in the tranexamic acid group compared with 21% in the control group (P=.0001). No significant difference was found in the autologous cell salvage requirement (.96 vs 1.01; P=.43) or the thromboembolic disease rate between the tranexamic acid group and the control group (2.67% vs 1.33%; P=.31). The use of intravenous tranexamic acid led to a decreased transfusion requirement with no increased risk of thromboembolic disease in this contemporary cohort of patients undergoing periacetabular osteotomy.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Intravenous Tranexamic Acid Decreases Allogeneic Transfusion Requirements in Periacetabular Osteotomy

Bryan¹,

Sanders²,

Trousdale³

et al. 2016

Orthopedics

View full text Add to dashboard Cite

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“…Polkowski et al [ 55 ], in a retrospective cohort, indicated that the risk of symptomatic DVT associated with PAO is low (1%) with use of aspirin 325 mg two times daily along with mechanical compression prophylaxis for 6 weeks. Furthermore, routine post-operative screening did not detect any patients with an asymptomatic DVT.…”

Section: Current Evidences Regarding Prevention Of Vte After Hpsmentioning

confidence: 99%

Venous thromboembolism prophylaxis after hip preservation surgery: a review and presentation of institutional experience

Rezaie

Azboy

Parvızı

2018

Journal of Hip Preservation Surgery

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Venous thromboembolism (VTE) is a serious complication after major orthopedic procedures. The best options for prevention of the VTE are still debated. The most popular evidence-based guidelines for prevention and treatment of VTE in orthopedic surgery addressed the total hip or knee arthroplasty and hip fractures as the major orthopedic surgeries. Majority of studies have evaluated the different modalities of the VTE prophylaxis in patients undergiong hip or knee arthroplasty. Hip preservation surgeries (HPS) including mini-open femoroacetabular osteoplasty, surgical dislocation of the hip, arthroscopic procedures, and periacetabular osteotomy (PAO) are gained popularity in recent two decades. The majority of these patients are young, healthy and active and may not be considered at high risk for VTE. The frequency of VTE in patients undergoing PAO seems to be low between 0 and 5%. There is a paucity of data regarding rates of VTE in young healthy patients undergoing HPS as well as the optimal prevention methods for VTE. Hence current VTE prevention guidelines do not cover HPS adequately. We aimed to review the available literature regarding VTE events and VTE prophylaxis options after HPS. We discussed the available and potential options for prophylaxis of VTE events in these procedures along with our experience in a large cohort of hip preservation surgery.

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“…They reported an overall incidence of VTE to be 0.94%. Polkowski et al studied the frequency of thromboembolic disease in adult patients undergoing PAO and receiving aspirin twice daily as well as mechanical prophylaxis by assessing an ultrasound at 1 week post-operatively [ 3 ]. They found a 1.3% rate of DVT on routine screening of 136 hips, with a mean patient age of 30 years (range 18–60 years).…”

Section: Discussionmentioning

confidence: 99%

Aspirin provides adequate VTE prophylaxis for patients undergoing hip preservation surgery, including periacetabular osteotomy

Azboy

Kheir

Huang

et al. 2018

Journal of Hip Preservation Surgery

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There are no clear guidelines regarding optimal venous thromboembolism (VTE) prophylaxis for patients undergoing hip preservation surgery (HPS), in particular pelvic osteotomy, which is considered to be a major orthopaedic procedure. The aim of this study was to determine the efficacy of aspirin for VTE prophylaxis in a large cohort of patients undergoing femoroacetabular osteoplasty (FAO) and periacetabular osteotomy (PAO). This was a retrospective study of prospectively collected data on patients undergoing HPS. A total of 603 patients (643 cases) underwent FAO and 80 patients (87 cases) underwent PAO between 2003 and 2016. The mean age of patients was 34.3 years (range 14.3–68.1 years). The type of VTE prophylaxis administered changed over time with earlier patients receiving warfarin (44 cases), followed by aspirin at 325 mg twice daily (448 cases), and most recently aspirin 81 mg twice daily (238 cases). The complications of symptomatic pulmonary embolism (PE), deep venous thrombosis (DVT) and major bleeding events within 90 days of surgery were documented. There were zero patients that developed major bleeding events or required evacuation of a hematoma. One patient who underwent FAO and received aspirin 325 mg, developed post-operative symptomatic DVT. One patient who underwent PAO and received aspirin 325 mg developed DVT and PE. This study demonstrates that the incidence of VTE following joint preservation procedure is acceptably low. Administration of aspirin to patients undergoing FAO or PAO appears to be adequate in reducing the risk of VTE. Only two patients in this cohort developed VTE following HPS.

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Screening for Deep Vein Thrombosis After Periacetabular Osteotomy in Adult Patients: Is It Necessary?

Abstract: Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Cited by 11 publications

References 14 publications

Intravenous Tranexamic Acid Decreases Allogeneic Transfusion Requirements in Periacetabular Osteotomy

Intravenous Tranexamic Acid Decreases Allogeneic Transfusion Requirements in Periacetabular Osteotomy

Venous thromboembolism prophylaxis after hip preservation surgery: a review and presentation of institutional experience

Aspirin provides adequate VTE prophylaxis for patients undergoing hip preservation surgery, including periacetabular osteotomy

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