Systematic review of risk prediction scores for venous thromboembolism following joint replacement

Kunutsor, Setor K; Beswick, Andrew D; Whitehouse, Michael R; Blom, Ashley W

doi:10.1016/j.thromres.2018.06.024

Cited by 20 publications

(20 citation statements)

References 49 publications

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“…This would allow for potential risk modification by adjusting thromboprophylaxis dosages or using additional antithrombotic medications known to affect TEG parameters. 24,25 Increased age and body mass index and female sex, which are factors known to be associated with increased risk for VTE, 26,27 were not found to be associated with hypercoagulable TEG values in our cohort at 2 and 6 weeks. This was likely due to the small sample size.…”

Section: Discussionmentioning

confidence: 54%

Identification of hypercoagulability with thrombelastography in patients with hip fracture receiving thromboprophylaxis

You

Skeith

Korley

et al. 2021

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Background: Venous thromboembolism (VTE) is the second most common complication after hip fracture surgery. We used thrombelastography (TEG), a whole-blood, point-of-care test that can provide an overview of the clotting process, to determine the duration of hypercoagulability after hip fracture surgery. Methods: In this prospective study, consecutive patients aged 51 years or more with hip fractures (trochanteric region or neck) amenable to surgical treatment who presented to the emergency department were eligible for enrolment. Thrombelastography, including calculation of the coagulation index (CI) (combination of 4 TEG parameters for an overall assessment of coagulation) was performed daily from admission until 5 days postoperatively, and at 2 and 6 weeks postoperatively. All patients received 28 days of thromboprophylaxis. We used single-sample t tests to compare mean maximal amplitude (MA) values (a measure of clot strength) to the hypercoagulable threshold of greater than 65 mm, a predictor of in-hospital VTE. Results: Of the 35 patients enrolled, 11 (31%) were hypercoagulable on admission based on an MA value greater than 65 mm, and 29 (83%) were hypercoagulable based on a CI value greater than 3.0; the corresponding values at 6 weeks were 23 (66%) and 34 (97%). All patients had an MA value greater than 65 mm at 2 weeks. Patients demonstrated normal coagulation on admission (mean MA value 62.2 mm [standard deviation (SD) 6.3 mm], p = 0.01) but became significantly hypercoagulable at 2 weeks (mean 71.6 mm [SD 2.6 mm], p < 0.001). There was a trend toward persistent hypercoagulability at 6 weeks (mean MA value 66.2 mm [SD 3.8 mm], p = 0.06). Conclusion: More than 50% of patients remained hypercoagulable 6 weeks after fracture despite thromboprophylaxis. Thrombelastography MA thresholds or a change in MA over time may help predict VTE risk; however, further study is needed.

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Section: Discussionmentioning

confidence: 54%

Identification of hypercoagulability with thrombelastography in patients with hip fracture receiving thromboprophylaxis

You

Skeith

Korley

et al. 2021

cjs

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“…This may be because they are either very extensive (ie, up to 26 predictors), lack performance, are impractical (ie, include blood measurements), or not properly validated (Table S1). 20 Moreover, unfortunately, none report any performance measures and therefore do not give objective information for potential users. Furthermore, important predictors such as start of mobilization or length of hospital stay are often missing.…”

Section: Current Predictive Models For Vte Following Tha or Tkamentioning

confidence: 99%

Preventing VTE following total hip and knee arthroplasty: Is prediction the future?

Nemeth

Nelissen

Arya

et al. 2021

Journal of Thrombosis and Haemostasis

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Venous thromboembolism (VTE) is a common complication following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Many guidelines advise on the ideal pharmacological thromboprophylaxis strategy; however, despite its use, approximately 1.5% of patients still develop symptomatic VTE. Considering the large number of THAs and TKAs performed worldwide (2.5 million in total), the impact of VTE following these interventions is enormous. This paper discusses a concept how to further lower rates of VTE and bleeding complications following surgery. By stratifying patients according to their risk, we can optimize the balance between VTE and bleeding for each individual. This way, low‐risk patients may be safely withheld from treatment (and avoid unnecessary bleeding complications and costs), whereas high‐risk patients should receive adequate therapy (for instance, an increased thromboprophylaxis dosage and duration). An individualized strategy requires a well‐functioning VTE prediction model following THA and TKA to help physicians to decide on optimal thromboprophylaxis therapy.

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“…2 infections were reported in patients with RA, 1 of which responded to antibiotics immediately following surgery and the other required revision 5.3 years following the initial procedure. Patients with RA have an increased risk of prosthetic joint infection following surgery (29,30). Kunutsor et al (30) found an increased relative risk of 1.68 (95% confidence interval [CI], 1.26-2.25) for patients who have taken steroids previously compared to patients who had never taken steroids.…”

Section: Discussionmentioning

confidence: 99%

Hip resurfacing arthroplasty for patients with inflammatory arthritis: a systematic review

Morse

2017

HIP International

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Systematic review of risk prediction scores for venous thromboembolism following joint replacement

Cited by 20 publications

References 49 publications

Identification of hypercoagulability with thrombelastography in patients with hip fracture receiving thromboprophylaxis

Identification of hypercoagulability with thrombelastography in patients with hip fracture receiving thromboprophylaxis

Preventing VTE following total hip and knee arthroplasty: Is prediction the future?

Hip resurfacing arthroplasty for patients with inflammatory arthritis: a systematic review

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