Spinal anesthesia increases the risk of venous thromboembolism in total arthroplasty

Nakamura, Mashio; Kamei, Masataka; Bito, Seiji; Migita, Kiyoshi; Miyata, Shigeki; Kumagai, Kenji; Abe, Isao; Nakagawa, Yasuaki; Nakayama, Yuichiro; Saito, Masanobu; Tanaka, Takaaki; Motokawa, Satoru

doi:10.1097/md.0000000000006748

Cited by 31 publications

(19 citation statements)

References 26 publications

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“…Many existed confounding factors (advanced age, preoperative comorbidities, anesthesia projects, etc.) could be significantly associated with the conclusions [ 20 , 21 ]. We considered that the different races, age ranges, cohort characteristics, preoperative comorbidities, inclusion criteria, and antithrombotic prophylactic treatments around the surgery could all be potential explanations for our different conclusions with some other reports.…”

Section: Discussionmentioning

confidence: 91%

Plasminogen activator inhibitor-1: a risk factor for deep vein thrombosis after total hip arthroplasty

et al. 2018

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BackgroundThe onset of deep vein thrombosis (DVT) in patients after total hip arthroplasty (THA) may expand or enlarge and subsequently lead to significant mortality. The objective of this study was to investigate potential risk factors for DVT in patients after THA.MethodsEligible patients with hip joint diseases who were scheduled for unilateral primary THA at our hospital were prospectively included into this study. The demographic and clinical features, preoperative plasma biomarkers were detailed, recorded, and compared. The multiple logistic regression analysis was used to evaluate potential risk factors for DVT.ResultsA total of 214 subjects were enrolled into our study cohort for the final analysis, and 23 of them have suffered DVT with an incidence of 9.5%. The performance of logistic regression analysis showed that preoperative expression of plasminogen activator inhibitor-1 (PAI-1) was an independent risk factor for the onset of DVT in patients after THA (OR 1.18, 95% CI 1.04–1.29; p = 0.011).ConclusionsOur study indicated preoperative plasma PAI-1 expression as an independent risk factor for DVT in patients who underwent THA.

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Section: Discussionmentioning

confidence: 91%

Plasminogen activator inhibitor-1: a risk factor for deep vein thrombosis after total hip arthroplasty

et al. 2018

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“…There are limitations in our study. Firstly, Previous studies have reported that epidural anesthesia was associated with a lower risk of postoperative venous thromboembolism 3 , as compared with that associated with spinal anesthesia. The reason is the superior pain relief afforded by epidural analgesia, which facilitates the early postoperative mobilization of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Firstly, spinal anesthesia was associated with a higher risk of postoperative venous thromboembolism, as compared with that associated with epidural anesthesia 3 . Secondly, the incidence of postdural puncture headache (PDPH) in pregnant women undergoing spinal anesthesia during cesarean section was 10.8 % 4,5 .…”

Section: Introductionmentioning

confidence: 99%

Intravertebral Anaesthesia For cesarean section

Wang

Xie

Chun

et al. 2019

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BACKGROUND: Although epidural and spinal anaesthesia in patients undergoing cesarean section is the general choice recently, both of the two anesthesia methods still have imperfects. Caudal anesthesia has been considered more appropriate for gynecological surgery. However, there is a lack of experiments on the effects of epidural block combined with caudal block anaesthesia for cesarean section. METHODS: One hundred and fifty patients undergoing elective cesarean section were recruited to this clinical trial and randomized to receive epidural block, subarachnoid block, and epidural block combined with caudal block. The primary objective was to compare and evaluate the clinical efficacy of three groups. Secondary outcomes included side effects and the quality of intraoperative and postoperative comfort assessment. RESULTS: The times to cryanaesthesia at T10 and time to maximum motor block were shorter in group SAB. The maximal sensory blockade spinal segments of group SAB(15.18±0.90)and EAC (14.74±1.16)were much more than group EPB(10.74±1.77). Compared to group EPB(155.40±13.28) and EAC(160.70±12.58), the duration of complete regression of motor block was longer in group SAB(190.00±13.25). The intraoperative quality of anesthesia was judged by the gynecologist was excellent in group EAC and SAB(P=0.005), and by the parturients was only best in group EAC(P=0.001). The parturients felt more comfortable after surgery in group EPB and group EAC(P=0.007). CONCLUSIONS: Epidural block combined with caudal block anaesthesia can achieve the same anesthetic effect as spinal anaesthesia which is bettter than epidural anaesthesia for elective cesarean section, and have the highest level of intraoperative and postoperative comfort for parturient.

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“…By supporting blood flow in the limbs, graduated compression stockings reduce the rate of DVT by approximately 57% after THA [ 16 ], and may reduce risk further when used while inpatient and at home [ 17 ]. There is also evidence that pre-operative common iliac vein compression increases VTE risk after THA, and that the choice of anesthesia may impact VTE risk for various reasons [ 18 , 19 ]. Rapid recovery programs and early mobilization may reduce the immobilization period after THA and TKA.…”

Section: Overview Of Venous Thromboembolismmentioning

confidence: 99%

An Update on Venous Thromboembolism Rates and Prophylaxis in Hip and Knee Arthroplasty in 2020

et al. 2020

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Patients undergoing total hip and knee arthroplasty are at high risk for venous thromboembolism (VTE) with an incidence of approximately 0.6–1.5%. Given the high volume of these operations, with approximately one million performed annually in the U.S., the rate of VTE represents a large absolute number of patients. The rate of VTE after total hip arthroplasty has been stable over the past decade, although there has been a slight reduction in the rate of deep venous thrombosis (DVT), but not pulmonary embolism (PE), after total knee arthroplasty. Over this time, there has been significant research into the optimal choice of pharmacologic VTE prophylaxis for individual patients, with the objective to reduce the rate of VTE while minimizing adverse side effects such as bleeding. Recently, aspirin has emerged as a promising prophylactic agent for patients undergoing arthroplasty due to its similar efficacy and good safety profile compared to other pharmacologic agents. However, there is no evidence to date that clearly demonstrates the superiority of any given prophylactic agent. Therefore, this review discusses (1) the current prevalence and trends in VTE after total hip and knee arthroplasty and (2) provides an update on pharmacologic VTE prophylaxis in regard to aspirin usage.

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Spinal anesthesia increases the risk of venous thromboembolism in total arthroplasty

Cited by 31 publications

References 26 publications

Plasminogen activator inhibitor-1: a risk factor for deep vein thrombosis after total hip arthroplasty

Plasminogen activator inhibitor-1: a risk factor for deep vein thrombosis after total hip arthroplasty

Intravertebral Anaesthesia For cesarean section

An Update on Venous Thromboembolism Rates and Prophylaxis in Hip and Knee Arthroplasty in 2020

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