High Rate of Deep-Vein Thrombosis in Asia after Major Orthopedic Surgery: The AIDA Study Final Results.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2580-2580
Author(s):  
Franco Piovella ◽  
Ching-Jen Wang ◽  
Housan Lu ◽  
Lee Kenneth ◽  
Lai Heng Lee ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Orthopedic Surgery ◽  
Lower Limbs ◽  
High Rate ◽  
Orthopedic Procedures ◽  
Thrombosis Prophylaxis ◽  
Vein Thrombosis ◽  
Asian Patients ◽  
Major Orthopedic Surgery ◽  
Deep Vein

Abstract Background: The incidence of post-surgical venous thromboembolism is thought to be low in Asian populations and routine thromboprophylaxis is not implemented. Objective: In this large multinational, multiethnic study, we evaluated the incidence of deep-vein thrombosis (DVT) patients undergoing major orthopedic surgery of the lower limbs. Methods: We performed a prospective epidemiological study in 19 centers across Asia (China, Indonesia, South Korea, Malaysia, Philippines, Taiwan and Thailand) in patients undergoing elective total hip replacement (THR), total knee replacement (TKR) or hip fracture surgery (HFS) not receiving pharmacological thromboprophylaxis. The primary endpoint was the rate of DVT of the lower limbs objectively documented by mandatory bilateral ascending venography performed 6 to 10 days after surgery and evaluated by a blinded central adjudication committee. Results: Overall, 407 Asian patients (20–99 years) undergoing THR (n=175), TKR (n=136) or HFS (n= 96) were recruited in 19 centres. 72.5% of the enrolled patients had adequate venograms. Total DVT was diagnosed in 121 of 295 evaluable patients (41.0%, [95% confidence interval: 35.4–46.7]). Proximal DVT was found in 30 patients (10.2% [7.0–14.2]). Total DVT and proximal DVT rates were the highest in TKR patients (58.1% and 17.1%, respectively), followed by HFS patients (42.0% and 7.2%, respectively), then THR patients (25.6% and 5.8%, respectively). DVT was more frequent in female patients aged at least 65 years. By-country analysis showed that the highest DVT rate was observed in Indonesia (78.6%) and the lowest in China (24.3%). By ethnic group, the lowest DVT rate was observed in Koreans (29.8%), while similar results were found in Chinese (45.0%) and in other non-Korean non-Chinese (46.3%) ethnic groups. Pulmonary embolism was clinically suspected in 10 of 407 patients (2.5%) and objectively confirmed in two patients (0.5%). Conclusions: Venographically detected thrombosis is well recognized as an appropriate surrogate for symptomatic outcomes and is the basis for the recommendation for routine prophylaxis in Western patients. The high rate of venographic thrombosis in Asian patients is similar to that observed in patients in Western countries. Thrombosis prophylaxis should therefore be considered in Asian patients undergoing major orthopedic procedures.

Untersuchung zum postoperativen Verlauf bei Patienten mit Hämophilie

2012 ◽  
Vol 32 (S 01) ◽  
pp. S45-S47 ◽  
Author(s):  
S. Krekeler ◽  
S. Alesci ◽  
W. Miesbach
Keyword(s):  
Surgical Procedures ◽  
Orthopedic Surgery ◽  
Hip Replacement ◽  
Orthopedic Procedures ◽  
Vein Thrombosis ◽  
Major Orthopedic Surgery ◽  
Lung Embolism ◽  
Total Knee ◽  
Deep Vein ◽  
Observation Period

SummaryThromboembolic complications may occur in patients with major operations even after routine thromboprophylaxis with low-molecularweight-heparin. In this retrospective, single center survey the post-operative course of patients with haemophilia was investigated. Patients, methods Overall, the postoperative course in 85 patients with haemophilia A and B (median age: 43 years, 18–73 years) and 139 surgical procedures was analyzed. The surgical procedures mainly consist of major orthopedic surgery (58 total knee replacement, 15 hip replacement, 17 other major orthopedic surgery, 15 minor orthopedic procedures). Additional surgical procedures were abdominal-surgical (18), urological (8), neurosurgical (5). Results During the post-operative observation period a small number of wound healing complications occurred (4%). None of the patients developed symptomatic deep vein thrombosis or lung embolism. Conclusion There seems to a decreased risk of postoperative thromboembolism in patients with haemophilia.

Rates of proximal deep vein thrombosis as assessed by compression ultrasonography in patients receiving prolonged thromboprophylaxis with low molecular weight heparin after major orthopedic surgery

2005 ◽  
Vol 94 (09) ◽  
pp. 532-536 ◽  
Author(s):  
Hans-Jürgen Hesselschwerdt ◽  
W. Dieter Paar ◽  
Karl-Ludwig von Hanstein ◽  
Sebastian Schellong
Keyword(s):  
Deep Vein Thrombosis ◽  
Orthopedic Surgery ◽  
Postoperative Phase ◽  
Rehabilitation Center ◽  
Vein Thrombosis ◽  
Rehabilitation Centers ◽  
Increased Risk ◽  
Major Orthopedic Surgery ◽  
Deep Vein ◽  
Compression Ultrasonography

SummaryPatients undergoing major orthopedic surgery are at an increased risk of thromboembolism even after the acute postoperative phase. Therefore, prolonged thromboprophylaxis is currently recommended and widely used. The length of hospital stay after major orthopedic surgery is steadily decreasing and most patients are transferred to specialized rehabilitation centers in the early postoperative phase. Consequently, thromboprophylaxis is usually given during the rehabilitation period. Previously there have been no systematic studies of how many patients with asymptomatic thrombosis are transferred to a rehabilitation center or how many patients develop deep vein thrombosis (DVT) during rehabilitation. In the present study, 238 patients who had undergone major orthopedic surgery were examined by compression ultrasonography on day 1 or 2 and on day 20 of their rehabilitation phase in order to detect asymptomatic proximal DVT. Sonograms were read centrally with blinding to the clinical course of the patients. All patients received standard thromboprophylaxis during the acute postoperative phase. Prolonged thromboprophylaxis with enoxaparin was given during the rehabilitation phase. The mean duration of thromboprophylaxis was 36.8 days. At admission to the rehabilitation center, proximal DVT was identified in 16 patients (6.7%). New proximal DVT at discharge from the rehabilitation center was identified in 3.2% of patients following prolonged thromboprophylaxis with enoxaparin. In conclusion, a considerable percentage of patients with asymptomatic proximal DVT are transferred to rehabilitation centers following major orthopedic surgery. Using prolonged thromboprophylaxis, new proximal DVTs will still develop during rehabilitation, but at a low rate.

Burden of Deep Vein Thrombosis in the Outpatient Setting Following Major Orthopedic Surgery

2008 ◽  
Vol 42 (9) ◽  
pp. 1216-1221 ◽  
Author(s):  
Edith A Nutescu ◽  
Andrew F Shorr ◽  
Eileen Farrelly ◽  
Ruslan Horblyuk ◽  
Laura E Happe ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Orthopedic Surgery ◽  
Outpatient Setting ◽  
Vein Thrombosis ◽  
Major Orthopedic Surgery ◽  
Deep Vein

scholarly journals Effect of ulinastatin combined rivaroxaban on deep vein thrombosis in major orthopedic surgery

2014 ◽  
Vol 7 (11) ◽  
pp. 918-921 ◽  
Author(s):  
Xi Yu ◽  
Yi Tian ◽  
Ka Wang ◽  
Ying-Lin Wang ◽  
Guo-Yi Lv ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Orthopedic Surgery ◽  
Vein Thrombosis ◽  
Major Orthopedic Surgery ◽  
Deep Vein

Limited diagnostic workup for deep vein thrombosis after major joint surgery

2008 ◽  
Vol 99 (06) ◽  
pp. 1112-1115 ◽  
Author(s):  
Luis Peidro ◽  
Carlos Resines ◽  
Carlos Garcés ◽  
José Fernández ◽  
Eduardo Garagorri ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Orthopedic Surgery ◽  
Clinical Investigation ◽  
Diagnostic Workup ◽  
Time Points ◽  
Vein Thrombosis ◽  
Major Orthopedic Surgery ◽  
Deep Vein ◽  
Compression Ultrasonography

SummaryWhile deep vein thrombosis (DVT) may be clinically suspected at several time points after major orthopedic surgery, clinical examination is often unreliable, and compression ultrasonography (CUS) screening at discharge is of limited value. A prospective cohort study was carried out in 1,033 consecutive patients who had undergone major hip or knee surgery, aimed to assess the accuracy of a strategy consisting of clinical investigation followed by CUS in the detection of proximal DVT before discharge. The circumferences of both legs were measured in all patients; those exhibiting >2 cm difference between them were considered to have suspected DVT, and underwent bilateral CUS. The same diagnostic workup was repeated on days 45 and 90 after surgery. Three patients developed pulmonary embolism (PE) during admission (one died). Five additional patients died before discharge. Routine clinical evaluation before discharge was done in 1,025 patients, and 105 (10%) had suspected DVT. CUS confirmed the diagnosis in 24 (2.3% of the overall series). After discharge, 59 patients had suspected DVT on day 45, 53 on day 90. DVT diagnosis was confirmed by CUS in 27 (26%).Three additional patients developed PE (1 fatal). This translates into a sensitivity of the routine examinations at discharge of 44%. A limited diagnostic workup for DVT before discharge has the capacity to identify 44% of those patients who will become symptomatic afterwards.

DEEP VEIN THROMBOSIS PROPHYLAXIS IN SURGICALLY TREATED FRACTURED HIP PATIENTS

1987 ◽  
Author(s):  
P J Powers ◽  
M Gent ◽  
R Jay ◽  
J Hirsh ◽  
M Levine ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Placebo Group ◽  
Venous Thrombosis ◽  
Major Complication ◽  
Lower Limbs ◽  
Thrombosis Prophylaxis ◽  
Double Blind ◽  
Vein Thrombosis ◽  
Warfarin Group ◽  
Deep Vein

Deep vein thrombosis is a major complication in'patients treated surgically for fractured hip. Methods employed toreduce the risk of thrombosis include dextran, ASA, warfarin, low or adjusted dose heparin and calf compression, but none has widespread acceptance.A randomized trial wascarried out to assess the effectiveness of sodium warfarinand acetyl salicylic acid(aspirin) compared to placebo inthe prevention of venous thrombosis in fractured hip patients. One hundred and ninty four patients were randomizedto receive warfarin (65 patients), ASA (66 patients) or placebo (63 patients).Prophylaxis commenced post operatively and continued for 21 days or until discharge, if earlier.Warfarin patients received 10 mg sodium warfarin orally as soon as possible after surgery. Warfarin was then given daily according to the prothrombin time (PT), to obtain a PT of 16 seconds on the 5th post operative day. The PT was maintain at 16 to 18 seconds until the end of treatment.ASA and placebo patients received enteric coated tablets, 650 mg twice daily, in a double blind fashion beginning as soon as possible post operatively and continuingto the end of treatment. Surveillance testing and I-fibrinogen leg scanning and impedance plethysmography was performed and venography was done if either test suggested thrombus at the popliteal vein or above. Otherwise venography was performed at day 21 or prior to discharge, if earlier. Venous thrombosis occurred in 13 patients (20%) in the warfarin group, 27 patients (^0.9%) in the ASA group, and 29 patients (46%) in the placebo group (P=0.005). Proximal vein thrombosis or pulmonary embolism occurred in 6patients (9.2%) in the warfarin group,7 patients (10.6%) in the ASA and 19 patients (30.2%) in the placebo group (P=0.002). Two major hemorrhages occurred in the warfarin group, none in the ASA group, and 2 in the placebo group.The results of this study show sodium warfarin to be safeand effective in reducing thromboembolic complications infractured hip patients and ASA to be effective in reducing thrombosis involving the proximal deep veins of the lower limbs in these patients.

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