Bin Abd Razak Hamid Rahmatullah, Binte Abd Razak Noorul Faeyza, Tan Hwee-Chye Andrew
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
J Arthroplasty. 2017 Mar;32(3):974-979. doi: 10.1016/j.arth.2016.09.008. Epub 2016 Sep 28.
This retrospective cohort study was designed to establish the prevalence of clinically significant venous thromboembolic events (VTE) in our patients undergoing total knee arthroplasty (TKA) without chemoprophylaxis.
A single-surgeon cohort of patients who underwent TKA from 2006 to 2014 were included. All patients had a pneumatic tourniquet applied and a drain inserted postoperatively. Tranexamic acid was not used perioperatively. All patients were under a standardized postoperative protocol with routine mechanical prophylaxis against VTE. None of the patients received prophylactic anticoagulation. All patients ambulated on the second postoperative day. Only symptomatic patients were referred for radiological examination to exclude VTE. We evaluated the patient demographics and calculated the prevalence of VTE in our cohort.
A total of 966 patients were reviewed. Mean age was 66.1 ± 7.8 years. Mean body mass index was 28.2 ± 4.7 kg/m. Mean tourniquet time was 53 ± 23 minutes. Patients stayed in hospital for a mean of 5.4 ± 3.1 days. There was 100% compliance to mechanical prophylaxis. And 11.1% of our patients were on concomitant antiplatelet or anticoagulant use. There were 8 patients with clinically significant VTE. This translates to a prevalence of 0.82%. Seven patients developed deep vein thrombosis and 1 patient died from massive pulmonary embolism.
The prevalence of clinically significant VTE in our patients who underwent TKA without routine chemoprophylaxis is 0.82%. With proper patient selection, risk stratification, and stringent perioperative protocols, routine chemoprophylaxis may not be necessary in Asians undergoing TKA.
本回顾性队列研究旨在确定在未接受化学预防的全膝关节置换术（TKA）患者中具有临床意义的静脉血栓栓塞事件（VTE）的发生率。
纳入2006年至2014年由同一外科医生实施TKA手术的患者队列。所有患者均使用了气动止血带，术后插入引流管。围手术期未使用氨甲环酸。所有患者均遵循标准化的术后方案，采用常规机械方法预防VTE。所有患者均未接受预防性抗凝治疗。所有患者术后第二天开始活动。仅对有症状的患者进行影像学检查以排除VTE。我们评估了患者的人口统计学特征，并计算了队列中VTE的发生率。
共纳入966例患者。平均年龄为66.1±7.8岁。平均体重指数为28.2±4.7kg/m²。平均止血带使用时间为53±23分钟。患者平均住院时间为5.4±3.1天。机械预防的依从率为100%。11.1%的患者同时使用抗血小板或抗凝药物。有8例患者发生了具有临床意义的VTE。这相当于发生率为0.82%。7例患者发生深静脉血栓形成，1例患者死于大面积肺栓塞。
在未进行常规化学预防的TKA患者中，具有临床意义的VTE发生率为0.82%。通过适当的患者选择、风险分层和严格的围手术期方案，亚洲人进行TKA时可能无需常规化学预防。
