Zhang Siyuan, Htet Kway Swar, Tan Xin Yang, Wang Xinyu, Wang Wilson, Chua Weiliang
Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore, 117597, Singapore.
Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore.
Knee Surg Relat Res. 2020 Nov 4;32(1):58. doi: 10.1186/s43019-020-00077-w.
Venous thromboembolism (VTE) is a serious complication that may occur after total knee arthroplasty (TKA), leading to the recommendation of routine chemoprophylaxis by international guidelines. This study aims to determine if short-duration chemoprophylaxis after TKA reduces the incidence of VTE in an Asian population.
A retrospective study of 316 patients who underwent unilateral primary TKA between 1 January 2011 and 31 December 2013 was conducted. All patients received mechanical prophylaxis. One hundred seventeen patients (37%) received additional chemoprophylaxis, whereas 199 patients (63%) did not. A Doppler ultrasound (DUS) of both lower limbs was conducted for all patients within 6 days after surgery (median = 3 days) to assess for both proximal and distal DVT. Chemoprophylaxis in the form of enoxaparin (low molecular weight heparin; LMWH), aspirin, or heparin was administered until patients had a normal DUS, for a median duration of 4 days. Patients were followed up clinically for a minimum of 6 months to monitor for delayed or recurrent VTE and at least 2 years for patient-reported outcome measures.
Overall, 24 patients (7.59%) developed deep vein thrombosis (DVT): three proximal and 21 distal DVTs. Twenty-three of the 24 patients were asymptomatic. Twenty of 199 patients (10.05%) with only mechanical prophylaxis developed DVT, whereas four of 117 patients (3.42%) with additional chemoprophylaxis developed DVT. Multivariate analysis showed that chemoprophylaxis use was associated with reduced incidence of DVT (odds ratio = 0.19, p value = 0.011). Other factors associated with increased DVT incidence include female gender (odds ratio = 5.45, p value = 0.034), positive history of cancer (odds ratio = 5.14, p value = 0.044), and increased length of stay in hospital (odds ratio = 1.19, p value < 0.001).
Our study has shown that despite the low incidence of DVT in Asian patients undergoing TKA, short-duration chemoprophylaxis might be effective in reducing the incidence of DVT. However, most DVTs observed in our study were distal and may be of limited clinical significance. Further studies are needed to investigate the impact of chemoprophylaxis use on the incidence of PE and overall mortality rates among Asian patients.
静脉血栓栓塞症（VTE）是全膝关节置换术（TKA）后可能发生的严重并发症，因此国际指南建议进行常规化学预防。本研究旨在确定TKA术后短期化学预防是否能降低亚洲人群VTE的发生率。
对2011年1月1日至2013年12月31日期间接受单侧初次TKA的316例患者进行回顾性研究。所有患者均接受机械预防。117例患者（37%）接受了额外的化学预防，而199例患者（63%）未接受。所有患者在术后6天内（中位数=3天）进行双下肢多普勒超声（DUS）检查，以评估近端和远端深静脉血栓形成（DVT）。采用依诺肝素（低分子量肝素；LMWH）、阿司匹林或肝素进行化学预防，直至患者DUS检查结果正常，中位持续时间为4天。对患者进行至少6个月的临床随访，以监测延迟或复发性VTE，并进行至少2年的患者报告结局测量。
总体而言，24例患者（7.59%）发生了深静脉血栓形成（DVT）：3例近端DVT和21例远端DVT。24例患者中有23例无症状。仅接受机械预防的199例患者中有20例（10.05%）发生DVT，而接受额外化学预防的117例患者中有4例（3.42%）发生DVT。多因素分析显示，使用化学预防与DVT发生率降低相关（比值比=0.19，p值=0.011）。与DVT发生率增加相关的其他因素包括女性（比值比=5.45，p值=0.034）、癌症阳性病史（比值比=5.14，p值=0.044）和住院时间延长（比值比=1.19，p值<0.001）。
我们的研究表明，尽管亚洲TKA患者DVT发生率较低，但短期化学预防可能有效降低DVT发生率。然而，我们研究中观察到的大多数DVT为远端，可能临床意义有限。需要进一步研究以调查化学预防的使用对亚洲患者肺栓塞发生率和总体死亡率的影响。
