Warwick D, Friedman R J, Agnelli G, Gil-Garay E, Johnson K, FitzGerald G, Turibio F M
University of Southampton, Southampton, Hampshire SO16 6UY, UK.
J Bone Joint Surg Br. 2007 Jun;89(6):799-807. doi: 10.1302/0301-620X.89B6.18844.
Patients who have undergone total hip or knee replacement (THR and TKR, respectively) are at high risk of venous thromboembolism. We aimed to determine the time courses of both the incidence of venous thromboembolism and effective prophylaxis. Patients with elective primary THR and TKR were enrolled in the multi-national Global Orthopaedic Registry. Data on the incidence of venous thromboembolism and prophylaxis were collected from 6639 THR and 8326 TKR patients. The cumulative incidence of venous thromboembolism within three months of surgery was 1.7% in the THR and 2.3% in the TKR patients. The mean times to venous thromboembolism were 21.5 days (sd 22.5) for THR, and 9.7 days (sd 14.1) for TKR. It occurred after the median time to discharge in 75% of the THR and 57% of the TKA patients who developed venous thromboembolism. Of those who received recommended forms of prophylaxis, approximately one-quarter (26% of THR and 27% of TKR patients) were not receiving it seven days after surgery, the minimum duration recommended at the time of the study. The risk of venous thromboembolism extends beyond the usual period of hospitalisation, while the duration of prophylaxis is often shorter than this. Practices should be re-assessed to ensure that patients receive appropriate durations of prophylaxis.
接受全髋关节置换术（THR）或全膝关节置换术（TKR）的患者发生静脉血栓栓塞的风险很高。我们旨在确定静脉血栓栓塞的发生率和有效预防措施的时间进程。择期初次进行THR和TKR的患者被纳入多国全球骨科登记处。收集了6639例THR患者和8326例TKR患者的静脉血栓栓塞发生率及预防措施的数据。手术三个月内，THR患者静脉血栓栓塞的累积发生率为1.7%，TKR患者为2.3%。THR患者发生静脉血栓栓塞的平均时间为21.5天（标准差22.5），TKR患者为9.7天（标准差14.1）。发生静脉血栓栓塞的THR患者中有75%以及TKA患者中有57%是在出院中位时间之后出现的。在接受推荐预防措施的患者中，约四分之一（THR患者中的26%和TKR患者中的27%）在术后七天（研究时推荐的最短持续时间）未继续接受预防措施。静脉血栓栓塞的风险在通常的住院期之后仍会持续，而预防措施的持续时间往往短于此。应重新评估相关做法，以确保患者接受适当时长的预防措施。
