Plante Sylvie, Belzile Etienne L, Fréchette Dominique, Lefebvre Jean
From the Department of Pharmacy, CHU de Québec-Université Laval, Hôpital St-François d'Assise, Québec, Que. (Plante, Fréchette); the Division of Orthopaedic Surgery, Department of Surgery, Université Laval, Québec, Que. (Belzile); and the Faculty of Pharmacy, Université Laval, Québec, Que. (Lefebvre).
Can J Surg. 2017 Feb;60(1):30-36. doi: 10.1503/cjs.008216.
Venous thromboembolic events (VTE) are a known and well-described complication following total knee arthroplasty (TKA). We sought to validate the American College of Chest Physicians thromboprophylaxis recommendations after elective TKA, paying special attention to our dose adjustments for weight, and their impact on VTE in our population.
We retrospectively investigated risk factors in patients undergoing TKA, focusing mainly on symptomatic VTE occurrence rates from deep vein thrombosis (DVT) or pulmonary embolism (PE). The anticoagulation protocol consisted of starting low molecular-weight heparin (LMWH) therapy, with dalteparin administered 12 h after surgery in patients who received general anesthesia or 24 h later in patients who received single-dose regional anesthesia.
Data from 346 patients (mean age 66.8 [range 24-91] yr) who underwent primary or revision TKA depicted an overall symptomatic VTE rate of 15%. The proximal DVT rate was 1.7%, and the nonfatal PE rate was 0.9%. The mean time to VTE diagnosis was 5.6 days. The first dalteparin dose was administered 19.5 (range 10-48) h after surgery in patients without VTE and 22.6 (range 11.5-52) h after surgery in patients with VTE ( = 0.003). With a first dose of dalteparin administered 12 h postoperatively, patients presented significantly lower DVT and PE rates than if it was administered 24 h postoperatively (8.5% v. 16.3%, = 0.048).
Delayed administration of LMWH has deleteriously impacted the VTE rate after TKA at our institution. Prompt initiation of LMWH (≤ 12 h after surgery) is appropriate, without increasing the risk of major bleeding.
静脉血栓栓塞事件（VTE）是全膝关节置换术（TKA）后一种已知且描述详尽的并发症。我们试图验证美国胸科医师学会关于择期TKA后血栓预防的建议，特别关注我们根据体重进行的剂量调整及其对我们人群中VTE的影响。
我们回顾性研究了接受TKA患者的危险因素，主要关注深静脉血栓形成（DVT）或肺栓塞（PE）导致的有症状VTE发生率。抗凝方案包括开始低分子量肝素（LMWH）治疗，接受全身麻醉的患者在术后12小时给予达肝素，接受单剂量区域麻醉的患者在术后24小时给予达肝素。
346例接受初次或翻修TKA的患者（平均年龄66.8岁[范围24 - 91岁]）的数据显示，总体有症状VTE发生率为15%。近端DVT发生率为1.7%，非致命性PE发生率为0.9%。VTE诊断的平均时间为5.6天。无VTE患者术后19.5（范围10 - 48）小时给予首剂达肝素，有VTE患者术后22.6（范围11.5 - 52）小时给予首剂达肝素（P = 0.003）。术后12小时给予首剂达肝素的患者，其DVT和PE发生率显著低于术后24小时给予首剂的患者（8.5%对16.3%，P = 0.048）。
在我们机构，延迟给予LMWH对TKA后的VTE发生率产生了有害影响。及时启动LMWH（术后≤12小时）是合适的，且不会增加大出血风险。
