McMaster University, Hamilton, Ontario, Canada.
Thromb Haemost. 2010 Jan;103(1):123-8. doi: 10.1160/TH09-07-0438. Epub 2009 Oct 26.
The in-hospital incidence of pulmonary embolism (PE) in patients undergoing elective joint arthroplasty who receive a minimum of 10 days of dalteparin prophylaxis is reported to be less than 1%. Recent clinical experience raised suspicion that the incidence of PE was significantly higher at our tertiary care institution. It was the objective of this study to determine the incidence of in-hospital PE and symptomatic deep-vein thrombosis following elective joint arthroplasty in patients who received a minimum of 10 days of dalteparin prophylaxis. Consecutive charts of patients who underwent elective joint arthroplasty at our institution between January 2008 and June 2008 were reviewed. Data on risk factors for venous thromboembolism, objectively documented venous thromboembolic events, and signs and symptoms of PE were abstracted. Patients who received concomitant warfarin in the postoperative period were excluded. The study population consisted of 437 knee arthroplasty and 246 hip arthroplasty patients. The incidence of in-hospital PE following knee arthroplasty and hip arthroplasty was 4.6% and 0.4%, respectively. One out of every 10 knee patients, and one out of every 20 hip patients underwent testing for pulmonary embolism. Pulmonary embolism was diagnosed a median of 3.5 days after knee arthroplasty. The incidence of in-hospital PE in knee arthroplasty patients who received dalteparin prophylaxis was significantly higher than expected. Potential explanations for this finding include poor efficacy of dalteparin started 12-24 hours postoperatively and/or a low threshold for ordering diagnostic imaging for PE. Studies to clarify these issues are needed.
接受达肝素预防治疗至少 10 天的择期关节置换术患者的院内肺栓塞（PE）发生率报告低于 1%。最近的临床经验引起了怀疑，即在我们的三级保健机构中 PE 的发生率明显更高。本研究的目的是确定接受达肝素预防治疗至少 10 天的择期关节置换术患者的院内 PE 和有症状的深静脉血栓形成的发生率。回顾了 2008 年 1 月至 6 月期间在我院接受择期关节置换术的患者的连续图表。提取了静脉血栓栓塞危险因素、客观记录的静脉血栓栓塞事件以及 PE 的体征和症状的数据。排除了术后同时接受华法林治疗的患者。研究人群包括 437 例膝关节置换术和 246 例髋关节置换术患者。膝关节置换术和髋关节置换术后院内 PE 的发生率分别为 4.6%和 0.4%。每 10 例膝关节患者中就有 1 例，每 20 例髋关节患者中就有 1 例接受了肺栓塞检测。膝关节置换术后中位数 3.5 天诊断为 PE。接受达肝素预防治疗的膝关节置换术患者的院内 PE 发生率明显高于预期。这种发现的可能解释包括术后 12-24 小时开始使用达肝素的疗效不佳和/或对 PE 进行诊断性影像学检查的门槛较低。需要研究来澄清这些问题。
