Short-duration chemoprophylaxis might reduce incidence of deep vein thrombosis in Asian patients undergoing total knee arthroplasty

Abstract

Background Venous thromboembolism (VTE) is a serious complication that may occur after total knee arthroplasty (TKA), leading to the recommendation of routine chemoprophylaxis by international guidelines. This study aims to determine if short-duration chemoprophylaxis after TKA reduces the incidence of VTE in an Asian population. Methods A retrospective study of 316 patients who underwent unilateral primary TKA between 1 January 2011 and 31 December 2013 was conducted. All patients received mechanical prophylaxis. One hundred seventeen patients (37%) received additional chemoprophylaxis, whereas 199 patients (63%) did not. A Doppler ultrasound (DUS) of both lower limbs was conducted for all patients within 6 days after surgery (median = 3 days) to assess for both proximal and distal DVT. Chemoprophylaxis in the form of enoxaparin (low molecular weight heparin; LMWH), aspirin, or heparin was administered until patients had a normal DUS, for a median duration of 4 days. Patients were followed up clinically for a minimum of 6 months to monitor for delayed or recurrent VTE and at least 2 years for patient-reported outcome measures. Results Overall, 24 patients (7.59%) developed deep vein thrombosis (DVT): three proximal and 21 distal DVTs. Twenty-three of the 24 patients were asymptomatic. Twenty of 199 patients (10.05%) with only mechanical prophylaxis developed DVT, whereas four of 117 patients (3.42%) with additional chemoprophylaxis developed DVT. Multivariate analysis showed that chemoprophylaxis use was associated with reduced incidence of DVT (odds ratio = 0.19, p value = 0.011). Other factors associated with increased DVT incidence include female gender (odds ratio = 5.45, p value = 0.034), positive history of cancer (odds ratio = 5.14, p value = 0.044), and increased length of stay in hospital (odds ratio = 1.19, p value < 0.001). Conclusions Our study has shown that despite the low incidence of DVT in Asian patients undergoing TKA, short-duration chemoprophylaxis might be effective in reducing the incidence of DVT. However, most DVTs observed in our study were distal and may be of limited clinical significance. Further studies are needed to investigate the impact of chemoprophylaxis use on the incidence of PE and overall mortality rates among Asian patients.

Risk factors for deep vein thrombosis even using low-molecular-weight heparin after total knee arthroplasty

“…It has long been widely debated whether prophylactic treatment for DVT is needed after TKA in Asians [4,6,[19][20][21]. In earlier studies, the results were mostly against the use of prophylactic treatments unless symptomatic DVT developed [19].…”

“…For Asians, there have been several studies that reported a reduced rate of DVT after TKA compared to the Western population [4,5,[13][14][15][16][17][18]. Therefore, there were debates on whether prophylactic treatment for DVT is actually needed after TKA for Asians [6,[19][20][21]. However, studies have shown that the DVT rate after TKA in the Asian population is increasing, with one study reporting a DVT incidence of up to 62.5% without prophylaxis [22][23][24].…”

“…However, studies have shown that the DVT rate after TKA in the Asian population is increasing, with one study reporting a DVT incidence of up to 62.5% without prophylaxis [22][23][24]. Because serious and fatal results can happen if DVT is not treated properly [2], it is now widely accepted that some forms of DVT prevention should be performed, even though some forms of DVT prevention is not up to Western countries [21].…”

Current status survey of the extramural hospital management of venous thromboembolism after total hip and knee arthroplasty in China

“…Despite considerable advances in surgical and anaesthetic techniques, venous thromboembolism (VTE) is still a common complication following major orthopaedic surgery [1,2]. The incidence of VTE ranges from 35 to 84 % of patients undergoing total hip and knee arthroplasty (THA/TKA) [1,[3][4][5]. VTE has become a severe postoperative complication leading to death in the perioperative period and unexpected deaths.…”

“…VTE has become a severe postoperative complication leading to death in the perioperative period and unexpected deaths. In these patients undergoing TKA, the incidence rate of VTE after the operation, including symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) [4], is approximately 0.45-5.30 %, while the rate of VTE in patients undergoing THA is approximately 0.24-1.60 % [6][7][8][9]. Although the overall DVT rates after TKA/THA have reduced over the past decade, the number of patients in the USA has increased with the rising amount of surgery [6].…”