Zambelli Roberto, Nemeth Banne, Touw Carolina E, Rosendaal Frits R, Rezende Suely M, Cannegieter Suzanne C
Department of Orthopedic Surgery, Rede Mater Dei de Saúde, Belo Horizonte, Brazil.
Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
J Thromb Haemost. 2021 Feb;19(2):444-451. doi: 10.1111/jth.15163. Epub 2021 Jan 5.
This study aimed at evaluating the effect of thrombophilia on the risk of venous thromboembolism (VTE) in patients undergoing any type of orthopedic surgery.
Patients undergoing orthopedic surgery are at high risk for VTE. Although patients with thrombophilia have an increased risk of VTE, it is currently unclear whether there is a synergetic effect in patients with thrombophilia who undergo orthopedic surgery.
Data from a large population-based case-control study (the Multiple Environmental and Genetic Assessment [MEGA] of risk factors for venous thrombosis study) were used. Odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for age, sex, and body mass index (BMI) (ORadj) were calculated for patients undergoing any orthopedic intervention.
Of 4721 cases and 5638 controls, 263 cases and 94 controls underwent orthopedic surgery. Patients who had any orthopedic intervention in the year before the index date were at higher risk of VTE (ORadj 3.7; 95% CI, 2.9-4.8) than those who did not undergo any orthopedic surgery. There was an additionally increased risk in patients with factor V Leiden (OR 17.5, 95% CI, 4.1-73.6), non-O blood group (OR 11.2; 95% CI, 3.4-34.0), or elevated plasma levels of factor VIII (OR 18.6; 95% CI, 7.4-46.9) all relative to patients without these defects, not undergoing orthopedic surgery.
Patients with factor V Leiden, high levels of factor VIII, or blood group non-O were found to have a high risk of VTE after orthopedic surgery. Identification of these patients may enable individualized thromboprophylactic treatment to efficiently reduce VTE risk.
本研究旨在评估血栓形成倾向对接受任何类型骨科手术患者发生静脉血栓栓塞症（VTE）风险的影响。
接受骨科手术的患者发生VTE的风险较高。尽管有血栓形成倾向的患者发生VTE的风险增加，但目前尚不清楚接受骨科手术的有血栓形成倾向的患者是否存在协同效应。
使用来自一项基于人群的大型病例对照研究（静脉血栓形成危险因素的多重环境与遗传评估[MEGA]研究）的数据。计算接受任何骨科干预的患者的比值比（OR）及95%置信区间（CI），并对年龄、性别和体重指数（BMI）进行校正（校正后的OR [ORadj]）。
在4721例病例和5638例对照中，263例病例和94例对照接受了骨科手术。在索引日期前一年接受任何骨科干预的患者发生VTE的风险（ORadj 3.7；95% CI，2.9 - 4.8）高于未接受任何骨科手术的患者。与没有这些缺陷且未接受骨科手术的患者相比，携带因子V莱顿突变（OR 17.5，95% CI，4.1 - 73.6）、非O血型（OR 11.2；95% CI，3.4 - 34.0）或血浆因子VIII水平升高（OR 18.6；95% CI，7.4 - 46.9）的患者发生VTE的风险进一步增加。
发现携带因子V莱顿突变、因子VIII水平高或非O血型的患者在骨科手术后发生VTE的风险较高。识别这些患者可能有助于进行个体化血栓预防治疗，以有效降低VTE风险。
