Section for Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark.
Thromb Haemost. 2019 Nov;119(11):1877-1885. doi: 10.1055/s-0039-1696686. Epub 2019 Oct 6.
Venous thromboembolism (VTE) is a serious complication to total hip and knee arthroplasty (THA/TKA). However, recent publications found low 90-day incidences of VTE with in-hospital only thromboprophylaxis after fast-track THA and TKA, but with a subgroup with VTE despite thromboprophylaxis.
We aimed to investigate in detail the incidence and risk for VTE despite ongoing thromboprophylaxis after fast-track THA and TKA.
This is a prospective unselected multicenter cohort from January 2010 to August 2017. Data on preoperative characteristics were entered into the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement database (www.FTHK.dk). Length of stay (LOS) and complete 90-day follow-up was obtained from the Danish National Patient Registry and review of medical records. Patients with preoperative use of potent anticoagulants were excluded.
Of 34,397 procedures, 32 (0.09%, 22.4% of all VTE) had VTE after median 2 (interquartile range: 2-4) days despite ongoing thromboprophylaxis. Twenty-nine (2.1% of LOS > 5 days) occurred with LOS > 5 days and 3 during primary admission with LOS ≤ 5 days. Note that 78% of VTEs despite ongoing thromboprophylaxis occurred without any identifiable pre-VTE complication. Risk factors were age from 81 to 85 years (odds ratio [OR] 6.3 [95% confidence interval: 1.8-22.4], = 0.005), body mass index (BMI) < 18.5 (OR 11.1 [1.1-109.2], = 0.040), BMI 35 to 40 (OR 5.1 [1.0-26.2], = 0.050), and BMI ≥ 40 (OR 21.8 [4.6-103.6], < 0.001).
VTE after fast-track THA/TKA occurred after median 2 days in 0.09% (22% of all VTE) despite ongoing thromboprophylaxis. Further investigation of this "high-risk" population might help to improve the optimal choice for patient-specific thromboprophylaxis to further reduce incidence of postoperative VTE.
静脉血栓栓塞症（VTE）是全髋关节和膝关节置换术（THA/TKA）的严重并发症。然而，最近的研究发现，采用快速康复路径的 THA 和 TKA 术后仅在住院期间进行血栓预防，90 天内 VTE 的发生率较低，但仍有部分患者发生 VTE 而未进行血栓预防。
我们旨在详细研究快速康复路径 THA 和 TKA 后持续血栓预防仍发生 VTE 的发生率和风险因素。
这是一项 2010 年 1 月至 2017 年 8 月期间前瞻性、非选择性的多中心队列研究。术前特征数据被输入到隆贝克基金会快速髋关节和膝关节置换数据库（www.FTHK.dk）。住院时间（LOS）和完整的 90 天随访从丹麦国家患者登记处获得，并对病历进行审查。排除术前使用强效抗凝剂的患者。
在 34397 例手术中，32 例（0.09%，所有 VTE 的 22.4%）尽管持续进行血栓预防，但在中位数为 2（四分位距：2-4）天后仍发生 VTE。29 例（LOS > 5 天的 2.1%）发生在 LOS > 5 天的患者中，3 例发生在 LOS ≤ 5 天的初次住院患者中。需要注意的是，尽管持续进行血栓预防，但 78%的 VTE 没有任何可识别的 VTE 前并发症。危险因素包括年龄 81-85 岁（比值比 [OR] 6.3 [95%置信区间：1.8-22.4]，= 0.005）、体重指数（BMI）<18.5（OR 11.1 [1.1-109.2]，= 0.040）、BMI 35-40（OR 5.1 [1.0-26.2]，= 0.050）和 BMI ≥40（OR 21.8 [4.6-103.6]，<0.001）。
尽管持续进行血栓预防，采用快速康复路径的 THA/TKA 术后中位 2 天内发生 VTE 的比例为 0.09%（所有 VTE 的 22%）。进一步研究这一“高危”人群可能有助于改善针对特定患者的血栓预防选择，从而进一步降低术后 VTE 的发生率。
