Venous Thromboembolism After Orthopaedic Surgery – How Long Is The Patient At Risk?

Abstract

Aim: Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in hospital with orthopaedic surgery already an established risk factor. This study aims to establish the length of time that a patient is at risk of sustaining a VTE post orthopaedic surgery. Method:A retrospective case series of all patients who underwent orthopaedic surgery between 2010 and 2014 whom re-presented with a VTE within one year of their initial operation. Demographic, operative and clinical information was obtained in order to identify potential risk factors.Results: 53 patients were identified as having a VTE within one year of discharge. The majority (63.4%) underwent lower limb arthroplasty. 29% of the cohort had either a family or personal history of VTE, 79% had ischaemic heart disease (IHD), hypertension or both. The average body mass index (BMI) of the cohort was 31.4; above the UK national average. 56.6% of the cohort developed a pulmonary embolism (PE) and 49% developed a deep vein thrombosis (DVT). Co-occurring DVT and PE was diagnosed in 5.6% of patients. The average length of time for readmission for patients to re-present at hospital with a PE was 122 days (range 4-361) and 107 days (range 7 -360) with a DVT. Conclusion:This study confirms the existence of pre-established risk factors for developing VTE including obesity, personal and family history of DVT, cardiovascular disease and lower limb arthroplasty. These risk factors are recognised despite patients receiving post-operative thromboprophylaxis.The findings of this study extend the current research by suggesting that patients presenting with known risk factors of developing VTE may be at risk for longer than the current guidelines cover for the administration of thromboprophylaxis. We propose further studies are needed to identify any potential requirements for more extensive VTE prophylaxis in this population.

Anticoagulant therapy in orthopedic surgery – a review on anticoagulant agents, risk factors, monitoring, and current challenges

“…Individual risk factors of VTE include previous VTE, high BMI, cardiovascular disease and older age, malignancy, hematological disorders, chronic renal failure, prolonged immobilisation, varicose veins, early ambulation within 48 h after surgery and Charlson comorbidity index ≥3. 2,43,44 Among the risk factors age, previous history, major orthopedic surgery were studied as high-risk VTE factors in orthopedic patients. A recent Japanese study concluded age >68 years (adjusted odds ratio: 1.06, 95% confidence interval [CI]: 1.03-1.09; p < 0.001) as a high-risk factor for VTE in orthopedic patients undergoing lower limb surgery.…”

Correlation of Wells Score, Caprine Score, and Padua Score with Risk of Hypercoagulation Condition Based on D-dimer in Intra-articular, Periarticular, and Degenerative Fracture Patients of Inferior Extremity

“…This scoring system is changed or modified for DVT probability by taking one of the other clinical features, that is, patients with a previous history of DVT given an additional one point. Based on the modified Wells score [9], Wells score is a scoring system to assess a person's risk of developing DVT that is consist of a history of active cancer (undergoing treatment in the past 6 months), calf swelling >3 cm, superficial venous dilatation, pitting edema, the previous history of DVT, swelling of the entire leg, tenderness along the venous system, paralysis or application of casts to the lower extremities, bed rest >3 days, and a history of the major surgery requiring regional or general anesthesia in the past 12 weeks, that in each point has +1 point. Therefore, alternative diagnosis is at least as likely as DVT point −2 point.…”