Jetty Vybhav, Glueck Charles J, Freiberg Richard A, Wang Ping
Orthopedics. 2016 Nov 1;39(6):e1052-e1057. doi: 10.3928/01477447-20160719-02. Epub 2016 Jul 27.
Venous thromboembolism is uncommon after knee arthroscopy, and there are no guidelines for thromboprophylaxis in elective routine knee arthroscopy. Preoperative evaluation of common thrombophilias should provide guidance for postarthroscopy thromboprophylaxis in otherwise healthy patients who are at high risk for venous thromboembolism. This study assessed 10 patients with venous thromboembolism after total hip or knee arthroplasty. Patients were assessed if venous thromboembolism occurred within 6 months after knee arthroscopy (n=10) or total hip or knee arthroplasty (n=21). This study assessed gene mutations (factor V Leiden, prothrombin G20210A, plasminogen activator inhibitor, methylenetetrahydrofolate reductase) and serologic thrombophilias (high levels of factors VIII and XI, homocysteine, anticardiolipin immunoglobulin G and immunoglobulin M antibodies, and lupus anticoagulant; low antigenic protein C, S, and free S; and antithrombin III deficiency). The same coagulation data were obtained for normal subjects (n=110). The major thrombophilias in the arthroscopy group were factor V Leiden heterozygosity (40%), high factor VIII level (50%), and high homocysteine (30%). The respective values in control subjects were 2% (P=.0004), 7% (P=.0011), and 5% (P=.02). When the arthroscopy group was compared with the 21 patients who had venous thromboembolism after total hip or knee arthroplasty, the sole difference was factor V Leiden heterozygosity, which was 40% vs 0%, respectively (P=.007). Although venous thromboembolism after knee arthroscopy is uncommon, to identify high-risk patients and guide postoperative thromboprophylaxis, the authors suggest routine preoperative measurement of 3 common familial thrombophilias: factor V Leiden, factor VIII, and homocysteine. [Orthopedics. 2016; 39(6):e1052-e1057.].
膝关节镜检查后静脉血栓栓塞并不常见，且对于择期常规膝关节镜检查，目前尚无血栓预防指南。对于静脉血栓栓塞高风险的健康患者，术前对常见易栓症的评估应为关节镜检查后的血栓预防提供指导。本研究评估了10例全髋关节或膝关节置换术后发生静脉血栓栓塞的患者。若静脉血栓栓塞发生在膝关节镜检查后6个月内（n = 10）或全髋关节或膝关节置换术后（n = 21），则对患者进行评估。本研究评估了基因突变（因子V莱顿突变、凝血酶原G20210A突变、纤溶酶原激活物抑制剂、亚甲基四氢叶酸还原酶）和血清易栓症（因子VIII和XI水平升高、同型半胱氨酸、抗心磷脂免疫球蛋白G和免疫球蛋白M抗体以及狼疮抗凝物；抗原性蛋白C、S和游离S水平降低；以及抗凝血酶III缺乏）。对正常受试者（n = 110）获取相同的凝血数据。关节镜检查组的主要易栓症为因子V莱顿杂合子（40%）、因子VIII水平升高（50%）和同型半胱氨酸水平升高（30%）。对照组的相应数值分别为2%（P = 0.0004）、7%（P = 0.0011）和5%（P = 0.02）。当将关节镜检查组与21例全髋关节或膝关节置换术后发生静脉血栓栓塞的患者进行比较时，唯一的差异是因子V莱顿杂合子，分别为40%和0%（P = 0.007）。尽管膝关节镜检查后静脉血栓栓塞并不常见，但为了识别高危患者并指导术后血栓预防，作者建议常规术前检测3种常见的家族性易栓症：因子V莱顿突变、因子VIII和同型半胱氨酸。[《骨科》。2016年；39(6):e1052 - e1057。]
