Dixon J, Ahn E, Zhou L, Lim R, Simpson D, Merriman E G
Haematology Department, Waitemata District Health Board, Auckland, New Zealand.
Intern Med J. 2015 Apr;45(4):416-22. doi: 10.1111/imj.12702.
BACKGROUND/AIM: Symptomatic venous thromboembolism (VTE) complicates approximately 4% of major orthopaedic surgical procedures performed without thromboprophylaxis. Randomised clinical trials demonstrate primary thromboprophylaxis reduces VTE rates to <1%, with low rates of clinically important bleeding, using low molecular weight heparin (LMWH), oral FXa inhibitors or thrombin inhibitors. We reviewed the rates of VTE in patients undergoing major hip/knee joint surgery at Waitemata District Health Board (WDHB).
Cases of VTE within 90 days of orthopaedic surgery were identified by retrospective audit of data from the haematology VTE database. The number of major hip/knee joint surgeries at WDHB from January 2006 to December 2010 was obtained from clinical coding data.
The cumulative incidence of VTE within 90 days of surgery was 3.29%. The median time from surgery to diagnosis was 7 days. Deep vein thrombosis comprised 75% of cases, 77.6% distal and 23.2% proximal. Pulmonary embolism comprised 26.5% of VTE; 47.7% had right heart strain on computed tomography/echocardiography. Hip fracture surgery comprised one-third of patients. Of patients developing VTE, 85.5% had chemical thromboprophylaxis - aspirin 73%, LMWH 20 mg 16%, LMWH 40 mg 16%, therapeutic LMWH 3%, unfractionated heparin twice daily 1%, and warfarin 4%; 75.6% received mechanical prophylaxis, while 4% of patients received no prophylaxis.
VTE incidence after major hip/knee joint surgery at WDHB is high, with pulmonary embolism comprising almost one-third of all VTE in this study, indicating the prophylaxis given is suboptimal. Implementation of appropriate, extended duration prophylaxis as per evidence-based guidelines is required to reduce these rates.
背景/目的：在未进行血栓预防的情况下，约4%的大型骨科手术会并发有症状的静脉血栓栓塞症（VTE）。随机临床试验表明，使用低分子量肝素（LMWH）、口服Xa因子抑制剂或凝血酶抑制剂进行一级血栓预防可将VTE发生率降至<1%，且具有临床意义的出血发生率较低。我们回顾了怀塔玛塔地区卫生局（WDHB）接受大型髋/膝关节手术患者的VTE发生率。
通过对血液学VTE数据库的数据进行回顾性审核，确定骨科手术后90天内发生VTE的病例。从临床编码数据中获取2006年1月至2010年12月WDHB进行的大型髋/膝关节手术数量。
手术后90天内VTE的累积发生率为3.29%。从手术到诊断的中位时间为7天。深静脉血栓形成占病例的75%，其中远端占77.6%，近端占23.2%。肺栓塞占VTE的26.5%；47.7%的患者在计算机断层扫描/超声心动图检查中有右心劳损。髋部骨折手术患者占三分之一。发生VTE的患者中，85.5%接受了药物血栓预防——阿司匹林73%、20mg LMWH 16%、40mg LMWH 16%、治疗性LMWH 3%、每日两次普通肝素1%、华法林4%；75.6%接受了机械预防，而4%的患者未接受任何预防。
WDHB大型髋/膝关节手术后VTE发生率较高，本研究中肺栓塞占所有VTE的近三分之一，表明所给予的预防措施并不理想。需要根据循证指南实施适当的、延长疗程的预防措施以降低这些发生率。
