Villemur B, Bosson J L, Diamand J M
Association de Formation continue en Angiologie Rhône-Alpes, Grenoble.
J Mal Vasc. 1998 Oct;23(4):257-62.
Duplex ultrasound scanning was performed to detect deep venous thrombosis (DVT) after hip or knee arthroplasty and evaluate application of the postoperative thromboprophylaxis consensus.
A prospective multicenter study was conducted between April 1995 and April 1996 in 16 centers. Thirty angiologists included 505 patients (370 in private clinics and 135 in university hospitals). Mean patient age was 71 years. There were 288 women. Hip arthroplasty was performed in 396 patients (78%) and knee arthroplasty in 109 (22%), under general anesthesia in 323. The postoperative thromboprophylaxis consensus was recalled prior to study onset and DVT was detected 8 and 10 days after surgery by duplex ultrasonography.
Thromboprophylaxis was prescribed by the anesthesiologist (57%), the surgeon (23%) or an angiologist (20%). Anticoagulation dosage was lower than the recommended dosage in 181 patients (36%). The prevalence of detected deep venous thrombosis was 14% (range 11-17%), including 21 cases of proximal DVT (4.2%), 33 of distal DVT (6.5%) and 17 of distal muscular DVT (3.4%). The risk of having a DVT was 1.6-fold higher in patients over 70 years of age (p = 0.04), 2.2-fold higher in case of general anesthesia (p = 0.03) and 2.1-fold higher in case of reduced mobility (p = 0.01). When heparin dosage was lower than the recommended consensus dosage, prevalence of DVT was 19% compared with 11% for patients who received the right dosage (RR = 1.7, p = 0.01).
Much progress is needed in the application of the postoperative consensus on thromboprophylaxis. The high prevalence of DVT despite preventive treatment indicates that systematic detection of DVT is useful, particularly in high-risk patients or when the recommended thromboprophylaxis cannot be applied.
采用双功超声扫描检测髋或膝关节置换术后的深静脉血栓形成（DVT），并评估术后血栓预防共识的应用情况。
1995年4月至1996年4月在16个中心进行了一项前瞻性多中心研究。30名血管造影师纳入了505例患者（私立诊所370例，大学医院135例）。患者平均年龄为71岁。女性有288例。396例患者（78%）接受髋关节置换术，109例（22%）接受膝关节置换术，323例在全身麻醉下进行手术。在研究开始前回顾术后血栓预防共识，并在术后8天和10天通过双功超声检查检测DVT。
血栓预防由麻醉医师（57%）、外科医生（23%）或血管造影师（20%）开具。181例患者（36%）的抗凝剂量低于推荐剂量。检测到的深静脉血栓形成的患病率为14%（范围11%-17%），包括21例近端DVT（4.2%）、33例远端DVT（6.5%）和17例远端肌肉DVT（3.4%）。70岁以上患者发生DVT的风险高1.6倍（p = 0.04），全身麻醉患者高2.2倍（p = 0.03），活动减少患者高2.1倍（p = 0.01）。当肝素剂量低于推荐的共识剂量时，DVT的患病率为19%，而接受正确剂量的患者为11%（RR = 1.7，p = 0.01）。
术后血栓预防共识的应用仍需取得很大进展。尽管进行了预防性治疗，但DVT的高患病率表明，系统检测DVT是有用的，特别是在高危患者中或无法应用推荐的血栓预防措施时。
