Nair Velu, Kumar Ratheesh, Singh Bikram Kumar, Sharma Ajay, Joshi Gururaj R, Pathak Kamal
Department of Internal Medicine, Armed Forces Medical College, Pune, India.
Indian J Orthop. 2013 Mar;47(2):161-7. doi: 10.4103/0019-5413.108953.
Postoperative thromboprophylaxis with low molecular weight heparin (LMWH) for an extended period of 4 weeks is now preferred over short term thromboprophylaxis in patients undergoing total hip/knee arthroplasty (THA/TKA). However, most of the data demonstrating the efficacy and safety of extended thromboprophylaxis and short term thromboprophylaxis is from clinical trials done in the West. In India, the data of the incidence of venous thromboembolism (VTE) following THA/TKA has been conflicting and the duration has not been clearly defined. The aim of the study was to evaluate and compare the efficacy of extended thromboprophylaxis over short term thromboprophylaxis in Indian patients undergoing elective THA/TKA surgeries.
A prospective arm of 197 consecutive patients undergoing elective THA/TKA surgeries who were administered extended thromboprophylaxis for 4 weeks was compared with a historical group of 795 patients who were administered short term thromboprophylaxis for only 7-11 days. In both groups, LMWH (enoxaparin) was used in a dose of 40 mg subcutaneously, in addition to mechanical thromboprophylaxis. Primary efficacy endpoint was objectively confirmed venous thromboembolism (VTE). The presence of DVT was confirmed by a combination of pretest scoring, D-dimer, and Color Doppler Flow Imaging (CDFI) of deep veins of the legs, and pulmonary thromboembolism (PTE) was confirmed by ventilation perfusion (V/Q) scan or pulmonary angiography. Fisher's exact test and t test were used for the statistical analysis. The baseline confounding factors were compared between the two groups using t test for comparing the means for continuous data and Fisher's exact test for categorical data.
In the prospective arm, only 1 patient developed symptomatic PTE compared to 26 (3.27%) cases of VTE (20 cases of PTE and 6 cases of DVT) in the retrospective group.
Extended thromboprophylaxis (for 4 weeks) was found to be more effective than short term thromboprophylaxis in minimizing the risk of postoperative VTE in patients who underwent THA/TKA.
对于接受全髋关节/膝关节置换术（THA/TKA）的患者，术后使用低分子量肝素（LMWH）进行为期4周的长期血栓预防现在比短期血栓预防更受青睐。然而，大多数证明长期血栓预防和短期血栓预防的有效性和安全性的数据来自西方进行的临床试验。在印度，THA/TKA后静脉血栓栓塞（VTE）的发生率数据一直存在矛盾，且持续时间尚未明确界定。本研究的目的是评估和比较在接受择期THA/TKA手术的印度患者中，长期血栓预防与短期血栓预防的疗效。
将197例接受择期THA/TKA手术并接受4周长期血栓预防治疗的连续患者的前瞻性队列与795例仅接受7 - 11天短期血栓预防治疗的历史队列进行比较。在两组中，除了机械性血栓预防措施外，均使用剂量为40mg皮下注射的LMWH（依诺肝素）。主要疗效终点是客观证实的静脉血栓栓塞（VTE）。通过预测试评分、D - 二聚体以及腿部深静脉彩色多普勒血流成像（CDFI）相结合来确认深静脉血栓形成（DVT）的存在，通过通气灌注（V/Q）扫描或肺血管造影来确认肺血栓栓塞（PTE）。采用Fisher精确检验和t检验进行统计分析。使用t检验比较连续数据的均值，使用Fisher精确检验比较分类数据，对两组之间的基线混杂因素进行比较。
在前瞻性队列中，只有1例患者发生有症状的PTE，而回顾性队列中有26例（3.27%）VTE病例（20例PTE和6例DVT）。
发现在接受THA/TKA的患者中，长期血栓预防（4周）在降低术后VTE风险方面比短期血栓预防更有效。
