Finsen V
Department of Orthopaedic Surgery, Trondheim University Hospital, Norway.
Ann Chir Gynaecol. 2001;90(2):105-8.
We have given seven to 14 days thrombosis prophylaxis after orthopaedic surgery. Recently, six weeks prophylaxis has been recommended. We wished to evaluate the implications of prolonging prophylaxis.
We made a very thorough search of the hospital register of diagnoses and the registers of the departments of radiology and nuclear medicine and determined the number of detected thromboembolic complications during a five and a half-year period.
We identified 91 cases (0.50%) with thromboembolism during the first six weeks after 18.368 orthopaedic operations: 1.4% after 836 total hip arthroplasties and 1.0% after 1.845 hip fractures. In these two groups 19 thromboembolic complications were registered after the second postoperative week. If it had been possible to prevent all of them by prolonging prophylaxis to six weeks, each avoided thromboembolism would have cost around US $ 23.700 in additional drug costs alone. One hip fracture patient died from probable thrombo-embolism during the second and one during the fourth postoperative week. No hip arthroplasty patients died from a probable thromboembolic complication during the third to sixth postoperative week.
We conclude that the frequency of clinically detectable thrombo-embolism and fatal pulmonary embolus is so low during the third to sixth postoperative weeks that prophylaxis beyond two weeks is unwarranted.
我们在骨科手术后给予7至14天的血栓预防措施。最近，有人建议进行六周的预防。我们希望评估延长预防措施的影响。
我们对医院的诊断登记册以及放射科和核医学科的登记册进行了非常全面的搜索，并确定了五年半期间检测到的血栓栓塞并发症的数量。
在18368例骨科手术后的前六周内，我们确定了91例（0.50%）血栓栓塞病例：836例全髋关节置换术后为1.4%，1845例髋部骨折后为1.0%。在这两组中，术后第二周后登记了19例血栓栓塞并发症。如果能够通过将预防措施延长至六周来预防所有这些并发症，那么每避免一例血栓栓塞仅额外的药物费用就约为23700美元。一名髋部骨折患者在术后第二周死于可能的血栓栓塞，另一名在术后第四周死亡。在术后第三至六周，没有全髋关节置换患者死于可能的血栓栓塞并发症。
我们得出结论，在术后第三至六周，临床可检测到的血栓栓塞和致命肺栓塞的发生率非常低，因此术后两周以上的预防措施是不必要的。
