Niki Yasuo, Matsumoto Hideo, Hakozaki Akihiro, Mochizuki Takeshi, Momohara Shigeki
Department of Orthopaedic Surgery, Keio University, Tokyo, Japan.
J Orthop Sci. 2010 Jan;15(1):57-63. doi: 10.1007/s00776-009-1410-3. Epub 2010 Feb 12.
Recent advances in the understanding of blood coagulation processes favor an inflammatory basis for thrombotic events. In this study, thrombotic risk after total knee arthroplasty (TKA) was assessed and compared between patients with rheumatoid arthritis (RA) and those with osteoarthritis (OA).
Subjects comprised 199 patients (238 knees) with RA and 156 patients (169 knees) with OA. Serum D-dimer levels were measured before and after the operation. Lowdose unfractionated heparin was given for 7 days when patients had a history of previous venous thromboembolism or had a D-dimer level or >or=10 microg/ml of D-dimer on postoperative day 1. Doppler ultrasonography (DUS) was routinely performed preoperatively and on postoperative day (POD) 7 for diagnosing a deep venous thrombosis (DVT).
D-dimer levels on PODs 0, 1, and 7 were, respectively, 4.6, 37.2, and 11.2 microg/ml for RA and 1.8, 42.3, and 13.6 microg/ml for OA. The incidence of DUS-confirmed DVT was 20.6% in the RA group and 43.2% in the OA group, indicating a much higher incidence of postoperative DVT in OA patients (P < 0.001). Interestingly, when patients taking nonsteroidal antiinflammatory drugs (NSAIDs) or those >65 years of age were excluded, the incidence of DVT was comparable in the RA and OA groups. Symptomatic pulmonary embolism and DVT occurred in two and one OA patients and in one and two RA patients, respectively, with one postdischarge DVT included in each group.
The present study revealed that the incidence of DVT following TKA was significantly lower in RA patients than in those with OA. However, when the patients were matched for age and NSAID use, the incidence of DVT was equivalent in the two groups. These findings may allow us to reconsider a prophylactic regimen for venous thromboembolism in patients with RA.
对血液凝固过程认识的最新进展支持血栓形成事件的炎症基础。在本研究中，评估并比较了类风湿关节炎（RA）患者和骨关节炎（OA）患者全膝关节置换术（TKA）后的血栓形成风险。
研究对象包括199例RA患者（238膝）和156例OA患者（169膝）。在手术前后测量血清D - 二聚体水平。当患者有既往静脉血栓栓塞病史或术后第1天D - 二聚体水平≥10μg/ml时，给予低剂量普通肝素7天。术前及术后第7天常规进行多普勒超声检查（DUS）以诊断深静脉血栓形成（DVT）。
RA患者术后第0、1和7天的D - 二聚体水平分别为4.6、37.2和11.2μg/ml，OA患者分别为1.8、42.3和13.6μg/ml。DUS确诊的DVT发生率在RA组为20.6%，在OA组为43.2%，表明OA患者术后DVT发生率高得多（P < 0.001）。有趣的是，排除服用非甾体抗炎药（NSAIDs）的患者或年龄>65岁的患者后，RA组和OA组的DVT发生率相当。有症状的肺栓塞和DVT分别发生在2例OA患者和1例RA患者以及1例OA患者和2例RA患者中，每组各包括1例出院后发生的DVT。
本研究表明，TKA后RA患者的DVT发生率明显低于OA患者。然而，当患者在年龄和NSAIDs使用方面匹配时，两组的DVT发生率相当。这些发现可能使我们重新考虑RA患者静脉血栓栓塞的预防方案。
