PCV4 PREVENTION OF DEEP-VEIN THROMBOSIS AFTER TOTAL KNEE ARTHROPLASTY IN ASIAN PATIENTS: COMPARISON OF PROPHYLAXIS WITH LOW MOLECULAR WEIGHT HEPARIN AND INDOMETHACIN

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.

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A randomised comparison of a foot pump and low-molecular-weight heparin in the prevention of deep-vein thrombosis after total knee replacement

Journal of Bone and Joint Surgery - British Volume ◽

10.1302/0301-620x.84b3.0840344 ◽

2002 ◽

Vol 84-B (3) ◽

pp. 344-350 ◽

Cited By ~ 6

Author(s):

D. Warwick ◽

J. Harrison ◽

S. Whitehouse ◽

A. Mitchelmore ◽

M. Thornton

Keyword(s):

Molecular Weight ◽

Deep Vein Thrombosis ◽

Total Knee Replacement ◽

Knee Replacement ◽

Low Molecular Weight Heparin ◽

Low Molecular Weight ◽

Vein Thrombosis ◽

Total Knee ◽

Deep Vein

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

Knee Surgery and Related Research ◽

10.1186/s43019-021-00109-z ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Joon Kyu Lee ◽

Kee Byoung Lee ◽

Joong Il Kim ◽

Gun Tae Park ◽

Young Chang Cho

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Molecular Weight ◽

Total Knee Arthroplasty ◽

Low Molecular Weight Heparin ◽

Low Molecular Weight ◽

Vein Thrombosis ◽

Total Knee ◽

Deep Vein ◽

Significant Factors

Abstract Background With an increase in deep vein thrombosis (DVT) following total knee arthroplasty (TKA) in the Asian population, most surgeons today use a form of prophylactic anticoagulant agents in patients after TKA. Nevertheless, DVT occasionally develops even in these patients with prophylaxis. The purpose of this study was to identify the risk factors for DVT after TKA in cases of postoperative low-molecular-weight heparin (LMWH) use. Methods We designed a retrospective study with 103 patients who underwent primary TKA. From the second postoperative day, 60 mg of LMWH was subcutaneously injected into the patients daily. On the seventh postoperative day, patients had computed tomography angiography to check whether they had DVT. Regarding risk factors, we investigated patients’ gender, age, surgical site (unilateral/bilateral), body mass index, method of anesthesia, preoperative hypertension, diabetes, hypercholesterolemia status, and prothrombin time/international normalized ratio from electronic medical records. We analyzed the statistical significance of these risk factors. Results Statistically significant factors in the single-variable analysis were surgical site (unilateral/bilateral), body mass index, preoperative hypertension status, and anesthesia method. Multiple logistic regression analysis with these factors revealed that the surgical site (unilateral/bilateral, p = 0.024) and anesthesia method (p = 0.039) were significant factors for the occurrence of postoperative DVT after TKA. Conclusions Patients undergoing simultaneous bilateral TKAs and patients undergoing TKA with general anesthesia need more attention regarding DVT even with chemoprophylaxis using LMWH after TKA.

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