Symptomatic In-Hospital Deep Vein Thrombosis and Pulmonary Embolism Following Hip and Knee Arthroplasty Among Patients Receiving Recommended Prophylaxis

AbstractTranexamic acid (TXA) has been shown to reduce blood loss and postoperative transfusions in total knee arthroplasty (TKA). There is no consensus on the ideal dosing regimen in the literature, although there is a growing body of literature stating there is little benefit to additional doses. Our study compared one versus two doses of TXA in primary TKA and its effect on postoperative transfusion rate. We retrospectively reviewed patients undergoing primary TKA at our two high-volume arthroplasty centers between 2013 and 2016. Patients were included if they underwent unilateral primary TKA, and received one or two doses of intravenous TXA. Patients receiving therapeutic anticoagulation were excluded. Our primary outcome was postoperative transfusion rate. Secondary outcomes included blood loss, length of stay, rate of deep vein thrombosis or pulmonary embolism (DVT/PE), readmission and reoperation.A total of 1,191 patients were included: 891 received one dose and 300 received two doses. There was no significant difference in rate of transfusion, deep vein thrombosis or pulmonary embolism (DVT/PE), blood volume loss, and reoperation. There was a significantly higher risk of readmission (6.7 vs. 2.4%, odds ratio [OR] 2.96, p < 0.001) and reoperation (2.0 vs. 0.6%, OR 3.61, p = 0.024) in patients receiving two doses. These findings were similar with subgroup analysis of patients receiving only aspirin prophylaxis.In unilateral TKA, there is no difference in transfusion rate with one or two doses of perioperative TXA. There was no increased risk of thromboembolic events between groups, although the two-dose group had a higher rate of readmission and reoperation. Given the added cost without clear benefit, these findings may support administration of one rather than two doses of TXA during primary TKA.

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Trends in Deep Vein Thrombosis Prophylaxis and Deep Vein Thrombosis Rates After Total Hip and Knee Arthroplasty

Journal of the American Academy of Orthopaedic Surgeons ◽

10.5435/jaaos-d-18-00635 ◽

2018 ◽

Vol 26 (23) ◽

pp. 852

Keyword(s):

Deep Vein Thrombosis ◽

Knee Arthroplasty ◽

Thrombosis Prophylaxis ◽

Total Hip ◽

Vein Thrombosis ◽

Deep Vein Thrombosis Prophylaxis ◽

Hip And Knee Arthroplasty ◽

Deep Vein

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Retrospective Derivation and Validation of an Automated Electronic Search Algorithm to Identify Post operative Cardiovascular and Thromboembolic Complications

Applied Clinical Informatics ◽

10.4338/aci-2015-03-ra-0026 ◽

2015 ◽

Vol 06 (03) ◽

pp. 565-576 ◽

Cited By ~ 9

Author(s):

M. Tien ◽

R. Kashyap ◽

G. A. Wilson ◽

V. Hernandez-Torres ◽

A. K. Jacob ◽

...

Keyword(s):

Myocardial Infarction ◽

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Knee Arthroplasty ◽

Search Algorithm ◽

Cardiovascular Complications ◽

Data Abstraction ◽

Vein Thrombosis ◽

Electronic Search ◽

Deep Vein

Summary Background: With increasing numbers of hospitals adopting electronic medical records, electronic search algorithms for identifying postoperative complications can be invaluable tools to expedite data abstraction and clinical research to improve patient outcomes. Objectives: To derive and validate an electronic search algorithm to identify postoperative thromboembolic and cardiovascular complications such as deep venous thrombosis, pulmonary embolism, or myocardial infarction within 30 days of total hip or knee arthroplasty. Methods: A total of 34 517 patients undergoing total hip or knee arthroplasty between January 1, 1996 and December 31, 2013 were identified. Using a derivation cohort of 418 patients, several iterations of a free-text electronic search were developed and refined for each complication. Subsequently, the automated search algorithm was validated on an independent cohort of 2 857 patients, and the sensitivity and specificities were compared to the results of manual chart review. Results: In the final derivation subset, the automated search algorithm achieved a sensitivity of 91% and specificity of 85% for deep vein thrombosis, a sensitivity of 96% and specificity of 100% for pulmonary embolism, and a sensitivity of 100% and specificity of 95% for myocardial infarction. When applied to the validation cohort, the search algorithm achieved a sensitivity of 97% and specificity of 99% for deep vein thrombosis, a sensitivity of 97% and specificity of 100% for pulmonary embolism, and a sensitivity of 100% and specificity of 99% for myocardial infarction. Conclusions: The derivation and validation of an electronic search strategy can accelerate the data abstraction process for research, quality improvement, and enhancement of patient care, while maintaining superb reliability compared to manual review. Citation: Tien M, Kashyap R, Wilson GA, Hernandez-Torres V, Jacob AK, Schroeder DR, Mantilla CB. Retrospective Derivation and Validation of an Automated Electronic Search Algorithm to Identify Postoperative Thromboembolic and Cardiovascular Complications. Appl Clin Inform 2015; 6: 565–576http://dx.doi.org/10.4338/ACI-2015-03-RA-0026

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