Venous thromboembolism after fast-track elective revision hip and knee arthroplasty – A multicentre cohort study of 2814 unselected consecutive procedures

2021 ◽  
Vol 199 ◽  
pp. 101-105
Author(s):  
Pelle Baggesgaard Petersen ◽  
Martin Lindberg-Larsen ◽  
Christoffer Calov Jørgensen ◽  
Henrik Kehlet ◽  
Frank Madsen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
Knee Arthroplasty ◽  
Fast Track ◽  
Multicentre Cohort Study ◽  
Hip And Knee Arthroplasty ◽  
Multicentre Cohort

scholarly journals Statin therapy and recurrent venous thromboembolism in the elderly: a prospective cohort study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Regula Monika Kronenberg ◽  
Shanthi Beglinger ◽  
Odile Stalder ◽  
Marie Méan ◽  
Andreas Limacher ◽  
...  
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
Propensity Scores ◽  
The Elderly ◽  
Confounding By Indication ◽  
Multicentre Cohort Study ◽  
Recurrent Venous Thromboembolism ◽  
Reduce Risk ◽  
Multicentre Cohort

Abstract Previous studies reported lower rates of recurrent venous thromboembolism (rVTE) among statin users, but this association could be influenced by concurrent anticoagulation and confounding by statin indication. This study aimed to confirm the beneficial association between statins and rVTE, stratified according to periods with and without anticoagulation, and additionally employ propensity score weighted approach to reduce risk of confounding by indication. The setting was a prospective multicentre cohort study and the outcome was time to first rVTE in statin vs. non-statin users. 980 participants with acute VTE were enrolled (mean age 75.0 years, 47% women), with median follow-up of 2.5 years. Of 241 (24.3%) statin users, 21 (8.7%) suffered rVTE vs. 99 (13.4%) among 739 non-users. The overall adjusted sub-hazard ratio (aSHR) for rVTE comparing statin users to non-users was 0.72 (95%CI 0.44 to 1.19, p = 0.20). This association was only apparent during periods without anticoagulation (aSHR 0.50, 95%CI 0.27 to 0.92, p = 0.03; vs. with anticoagulation: aSHR 1.34, 95%CI 0.54 to 3.35, p = 0.53). Using propensity scores, the rVTE risk during periods without anticoagulation fell further (aSHR 0.20, 95%CI 0.08 to 0.49, p < 0.001). In conclusion, statin use is associated with a more pronounced risk reduction for rVTE than previously estimated, but only during periods without anticoagulation.

scholarly journals Thromboprophylaxis only during hospitalisation in fast-track hip and knee arthroplasty, a prospective cohort study

BMJ Open ◽  
2013 ◽  
Vol 3 (12) ◽  
pp. e003965 ◽  
Author(s):  
Christoffer C Jørgensen ◽  
Michael K Jacobsen ◽  
Kjeld Soeballe ◽  
Torben B Hansen ◽  
Henrik Husted ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Knee Arthroplasty ◽  
Prospective Cohort ◽  
Fast Track ◽  
Hip And Knee Arthroplasty

scholarly journals Days alive and out of hospital after fast-track total hip and knee arthroplasty: an observational cohort study in 16 137 patients

2019 ◽  
Vol 123 (5) ◽  
pp. 671-678 ◽  
Author(s):  
Christoffer C. Jørgensen ◽  
Pelle B. Petersen ◽  
Henrik Kehlet ◽  
Frank Madsen ◽  
Torben B. Hansen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Knee Arthroplasty ◽  
Fast Track ◽  
Observational Cohort Study ◽  
Total Hip ◽  
Hip And Knee Arthroplasty ◽  
Observational Cohort

Safety of In-Hospital Only Thromboprophylaxis after Fast-Track Total Hip and Knee Arthroplasty: A Prospective Follow-Up Study in 17,582 Procedures

2018 ◽  
Vol 118 (12) ◽  
pp. 2152-2161 ◽  
Author(s):  
Pelle Petersen ◽  
Henrik Kehlet ◽  
Christoffer Jørgensen ◽  
Keyword(s):  
Cohort Study ◽  
Knee Arthroplasty ◽  
Fast Track ◽  
Total Hip ◽  
Vein Thrombosis ◽  
Co Morbidity ◽  
National Patient ◽  
Hip And Knee Arthroplasty ◽  
Associated Risk Factors

AbstractMost international guidelines recommend pharmacological thromboprophylaxis after total hip and knee arthroplasty (THA/TKA) for 10 to 35 days. However, a recent cohort study on fast-track THA and TKA questioned the need for prolonged thromboprophylaxis when length of stay (LOS) is ≤ 5 days. We aimed at re-investigating the incidence of venous thromboembolism (VTE) in fast-track THA and TKA with in-hospital only thromboprophylaxis when LOS was ≤ 5 days. Prospective cohort study from 1 December 2011 to 30 October 2015 on elective unilateral THA/TKA with in-hospital only thromboprophylaxis if LOS was ≤ 5 days. Prospective information on co-morbidity and complete 90-day follow-up through the Danish National Patient Registry and medical records. Patients with pre-operative use of anticoagulants were excluded. In per protocol analysis, 17,582 (95.5%) had LOS of ≤ 5 days (median, 2 [interquartile range, 2–3]) and in-hospital thromboprophylaxis only. Incidence of symptomatic VTE was 0.40%, consisting of 28 (0.16%) pulmonary embolisms (PEs), 38 (0.22%) deep vein thrombosis (DVT) and 4 (0.02%) combined DVT and PE. Two PEs (0.01%) were fatal. VTE-associated risk factors with in-hospital only thromboprophylaxis were age > 85 years, odds ratio (OR) of 3.74 (95% confidence interval: 1.15–12.14, p = 0.028), body mass index (BMI) of 35 to 40, OR of 2.55 (1.02–6.35, p = 0.045) and BMI > 40, OR of 3.28 (1.02–10.56, p = 0.046). In conclusion, 90-day incidence of VTE after fast-track THA and TKA with in-hospital thromboprophylaxis only was 0.40%. Prolonged thromboprophylaxis may be reserved for LOS > 5 days or specific high-risk patients, but requires further studies regarding optimal type and duration of thromboprophylaxis.

Venous Thromboembolism despite Ongoing Prophylaxis after Fast-Track Hip and Knee Arthroplasty: A Prospective Multicenter Study of 34,397 Procedures

2019 ◽  
Vol 119 (11) ◽  
pp. 1877-1885 ◽  
Author(s):  
Pelle Baggesgaard Petersen ◽  
Christoffer Calov Jørgensen ◽  
Henrik Kehlet ◽  
Keyword(s):  
Venous Thromboembolism ◽  
Knee Arthroplasty ◽  
Fast Track ◽  
Optimal Choice ◽  
Patient Specific ◽  
High Risk Population ◽  
Complication Risk ◽  
National Patient ◽  
Hip And Knee Arthroplasty

Abstract Introduction Venous thromboembolism (VTE) is a serious complication to total hip and knee arthroplasty (THA/TKA). However, recent publications found low 90-day incidences of VTE with in-hospital only thromboprophylaxis after fast-track THA and TKA, but with a subgroup with VTE despite thromboprophylaxis. Objectives We aimed to investigate in detail the incidence and risk for VTE despite ongoing thromboprophylaxis after fast-track THA and TKA. Materials and Methods This is a prospective unselected multicenter cohort from January 2010 to August 2017. Data on preoperative characteristics were entered into the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement database (www.FTHK.dk). Length of stay (LOS) and complete 90-day follow-up was obtained from the Danish National Patient Registry and review of medical records. Patients with preoperative use of potent anticoagulants were excluded. Results Of 34,397 procedures, 32 (0.09%, 22.4% of all VTE) had VTE after median 2 (interquartile range: 2–4) days despite ongoing thromboprophylaxis. Twenty-nine (2.1% of LOS > 5 days) occurred with LOS > 5 days and 3 during primary admission with LOS ≤ 5 days. Note that 78% of VTEs despite ongoing thromboprophylaxis occurred without any identifiable pre-VTE complication. Risk factors were age from 81 to 85 years (odds ratio [OR] 6.3 [95% confidence interval: 1.8–22.4], p = 0.005), body mass index (BMI) < 18.5 (OR 11.1 [1.1–109.2], p = 0.040), BMI 35 to 40 (OR 5.1 [1.0–26.2], p = 0.050), and BMI ≥ 40 (OR 21.8 [4.6–103.6], p < 0.001). Conclusion VTE after fast-track THA/TKA occurred after median 2 days in 0.09% (22% of all VTE) despite ongoing thromboprophylaxis. Further investigation of this “high-risk” population might help to improve the optimal choice for patient-specific thromboprophylaxis to further reduce incidence of postoperative VTE.

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