Department of Endocrinology, Beijing Jishuitan Hospital, Beijing, China.
Department of Spine Surgery, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, 100035, Beijing, People's Republic of China.
BMC Musculoskelet Disord. 2021 Jul 6;22(1):608. doi: 10.1186/s12891-021-04453-9.
Venous thromboembolism (VTE) is a significant complication after joint arthroplasty. Diabetes is related to a few changes in coagulation and fibrinolysis that may lead to thrombophilia. We aimed to investigate the incidence of postoperative VTE and associated risk factors among patients with diabetes undergoing total hip (THA) or total knee anthroplasty (TKA) in a single centre in China.
Patients with diabetes who underwent THA or TKA from January 2016 to December 2018 (n = 400) at Beijing Jishuitan Hospital were recruited in this study. Lower limb venous Doppler ultrasound was performed before and after surgery to confirm deep venous thrombosis (DVT). Computer tomography pulmonary angiography was done to confirm pulmonary embolism (PE) for those with new postoperative DVT and typical symptoms of PE. A multivariate logistic regression model was conducted to examine factors associated with the development of postoperative VTE.
The overall incidence of postoperative VTE in patients with diabetes after THA or TKA was 46.8 % (187 out of 400). Among the 187 VTE patients, 7.5 % (14 out of 187) had proximal vein thrombosis and 92.5 % (173 out of 187) had distal vein thrombosis. No PE occurred. Female patients and patients undergoing TKA had higher incidence of postoperative VTE. Patients who developed postoperative VTE were older, and had higher levels of preoperative D-Dimer and Caprini score. A high level of preoperative D-dimer (OR = 2.11, 95 %CI = 1.35-3.30) and the surgery of TKA (OR = 2.29, 95 %CI = 1.29-4.01) significantly increased the risk of developing postoperative VTE. Postoperative initiation of concomitant mechanical prophylaxis and low molecular weight heparin (LMWH) was protective for postoperative VTE (OR = 0.56, 95 %CI = 0.37-0.86).
VTE is common in patients with diabetes undergoing joint arthroplasty. Patients undergoing TKA or with a high level of preoperative D-dimer are at a considerable risk of developing postoperative VTE. There may be a protective role of postoperative initiation of concomitant mechanical prophylaxis and LMWH for VTE.
静脉血栓栓塞症（VTE）是关节置换术后的一种严重并发症。糖尿病与凝血和纤维蛋白溶解的一些变化有关，这些变化可能导致血栓形成倾向。我们旨在研究在中国一家中心接受全髋关节置换术（THA）或全膝关节置换术（TKA）的糖尿病患者术后 VTE 的发生率和相关危险因素。
本研究纳入了 2016 年 1 月至 2018 年 12 月在北京积水潭医院接受 THA 或 TKA 的糖尿病患者（n=400）。手术前后对下肢静脉多普勒超声进行检查以确认深静脉血栓形成（DVT）。对术后新发 DVT 且有典型 PE 症状的患者行计算机断层肺动脉造影以确诊肺栓塞（PE）。采用多变量 logistic 回归模型分析术后 VTE 发生的相关因素。
THA 或 TKA 后糖尿病患者术后 VTE 的总发生率为 46.8%（400 例患者中有 187 例）。在 187 例 VTE 患者中，7.5%（14 例）有近端静脉血栓形成，92.5%（173 例）有远端静脉血栓形成。无 PE 发生。女性患者和接受 TKA 的患者术后 VTE 发生率较高。发生术后 VTE 的患者年龄较大，术前 D-二聚体和 Caprini 评分水平较高。术前高水平 D-二聚体（OR=2.11，95%CI=1.35-3.30）和 TKA 手术（OR=2.29，95%CI=1.29-4.01）显著增加了术后 VTE 的风险。术后同时使用机械预防和低分子肝素（LMWH）可降低术后 VTE 的风险（OR=0.56，95%CI=0.37-0.86）。
VTE 在接受关节置换术的糖尿病患者中很常见。接受 TKA 或术前高水平 D-二聚体的患者发生术后 VTE 的风险较高。术后同时使用机械预防和 LMWH 可能对 VTE 有保护作用。
