Open Access, Peer-reviewed
pISSN 1226-2102
eISSN 2005-8918
    J Korean Orthop Assoc. 2012 Apr;47(2):86-95. Korean.
    Published online Apr 30, 2012.
    https://doi.org/10.4055/jkoa.2012.47.2.86
    Copyright © 2012 by The Korean Orthopaedic Association
    Original Article

    The Prophylaxis of Venous Thromboembolism in Korean Patients with Total Knee Replacement Arthroplasty

    Jin-Kyu Lee, M.D., Kyu-Sung Chung, M.D., Seung-Wook Baek, M.D. and Choong-Hyeok Choi, M.D.
      • Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, Korea.
    • Correspondence to: Choong-Hyeok Choi, M.D. Department of Orthopedic Surgery, College of Medicine, Hanyang University, 17, Haengdang-dong, Seongdong-gu, Seoul 133-792, Korea. TEL: +82-2-2290-8483 or 8485, FAX: +82-2-2299-3774, Email: chhchoi@hanyang.ac.kr
    Received April 28, 2011; Revised July 13, 2011; Accepted November 21, 2011.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Purpose

    To evaluate the effects and problems of venous thromboembolism (VTE) prophylaxis with a reduced dosage and administration period in Korean total knee arthroplasty (TKA) patients.

    Materials and Methods

    We analyzed 135 consecutive TKA patients with three different VTE prophylaxis regimens. Group dalteparin-aspirin (DA) injected dalteparin for the first 2 days, followed by taking aspirin for the next 5 days, Group aspirin (A) was on aspirin and Group dalteparin (D) on dalteparin 7 days postoperatively. We evaluated the incidence of VTE and safety among the 3 groups.

    Results

    Symptomatic deep vein thrombosis was detected in 4 cases (Group DA: 2, Group A: 1, Group D: 1). Pulmonary embolism (PE) was found in 1 case in each group with no fatal PE. Although no major bleeding complications were seen, minor bleeding incidents were detected in 14 cases (Group DA: 2, Group A: 1, Group D: 11), which was significant in Group D. No significant differences were observed in perioperative blood loss, effusion in the knee joint, thigh swelling or oozing on the wound area among the groups except thigh bruising, which developed more frequently in group D.

    Conclusion

    The reduced dosage and administration period of VTE prophylactic medicine combined with mechanical prophylaxis for Korean TKA patients showed no fatal PE, but some minor bleeding incidents frequently developed with 7 days of dalteparin injections. We need to adjust the dosage and duration of prophylactic medication deliberately for Korean TKA patients, considering prophylaxis effectiveness and bleeding complication risks.

    Keywords
    arthroplasty, replacement, knee; venous thromboembolism; deep vein thrombosis; pulmonary embolism; bleeding

    Figures

    Figure 1
    A 75-year-old woman, who underwent total knee arthroplasty on her right knee, was diagnosed with deep vein thrombosis in the calf muscular tributary vein (arrow) by computed tomographic angiography.

    Figure 2
    A 74-year-old woman, who underwent total knee arthroplasty on her right knee, was diagnosed with thrombus at the popliteal area (A) and at the pulmonary vessel (B). These figures demonstrate deep vein thrombosis at the popliteal vein (arrow) and pulmonary embolism at right lower lobe basal segmental pulmonary artery (arrowhead) by computed tomographic angiography.

    Tables

    Table 1
    Baseline Demographics and Clinical Characteristics of Population

    Table 2
    Incidence of Deep Vein Thrombosis, Pulmonary Embolism in Population after TKA

    Table 3
    Comparisons of Drainage Amount

    Table 4
    Hemorrhage according to Treatment Regimen

    Table 5
    Comparison of Clinical Outcomes

    References

      1. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133 6 Suppl:381S–453S.
      1. Kim YH, Yoo JH, Kim JS. Factors leading to decreased rates of deep vein thrombosis and pulmonary embolism after total knee arthroplasty. J Arthroplasty 2007;22:974–980.
      1. Cha SI, Lee SY, Kim CH, et al. Venous thromboembolism in Korean patients undergoing major orthopedic surgery: a prospective observational study using computed tomographic (CT) pulmonary angiography and indirect CT venography. J Korean Med Sci 2010;25:28–34.
      1. Virchow R. In: Cellular pathology as based upon physiological and pathologic histology: local formation of fibrin. London: Chruchil; 1860.
      1. Geerts WH, Heit JA, Clagett GP, et al. Prevention of venous thromboembolism. Chest 2001;119 1 Suppl:132S–175S.
      1. Seon JK, Song EK, Yoon TR, Park SJ, Bae BH, Cho SG. Comparison of functional results with navigation-assisted minimally invasive and conventional techniques in bilateral total knee arthroplasty. Comput Aided Surg 2007;12:189–193.
      1. Pandit H, Aslam N, Pirpiris M, Jinnah R. Total knee arthroplasty: the future. J Surg Orthop Adv 2006;15:79–85.
      1. Unay K, Akan K, Sener N, Cakir M, Poyanli O. Evaluating the effectiveness of a deep-vein thrombosis prophylaxis protocol in orthopaedics and traumatology. J Eval Clin Pract 2009;15:668–674.
      1. Demey G, Servien E, Pinaroli A, Lustig S, Aït Si Selmi T, Neyret P. The influence of femoral cementing on perioperative blood loss in total knee arthroplasty: a prospective randomized study. J Bone Joint Surg Am 2010;92:536–541.
      1. Mercuriali F, Inghilleri G. Proposal of an algorithm to help the choice of the best transfusion strategy. Curr Med Res Opin 1996;13:465–478.
      1. Nadler S, Hidalgo J, Bloch T. Prediction of blood volume in normal human adults. Surgery 1962;51:224–232.
      1. Fuji T, Ochi T, Niwa S, Fujita S. Prevention of postoperative venous thromboembolism in Japanese patients undergoing total hip or knee arthroplasty: two randomized, double-blind, placebo-controlled studies with three dosage regimens of enoxaparin. J Orthop Sci 2008;13:442–451.
      1. Kane D, Balint PV, Sturrock RD. Ultrasonography is superior to clinical examination in the detection and localization of knee joint effusion in rheumatoid arthritis. J Rheumatol 2003;30:966–971.
      1. Warwick D, Harrison J, Glew D, Mitchelmore A, Peters TJ, Donovan J. Comparison of the use of a foot pump with the use of low-molecular-weight heparin for the prevention of deep-vein thrombosis after total hip replacement. A prospective, randomized trial. J Bone Joint Surg Am 1998;80:1158–1166.
      1. Callaghan JJ, Dorr LD, Engh GA, et al. American Colleg of Chest Physicians. Prophylaxis for thromboembolic disease: recommendations from the American College of Chest Physicians--are they appropriate for orthopaedic surgery? J Arthroplasty 2005;20:273–274.
      1. Haas SB, Barrack RL, Westrich G, Lachiewicz PF. Venous thromboembolic disease after total hip and knee arthroplasty. J Bone Joint Surg Am 2008;90:2764–2780.
      1. American academy of orthopaedic surgeons clinical guideline on prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty. American Academy of Orthopaedic Surgeons Board of Directors. 2007 May [accessed 2009 Sep 9].
        Available from: www.aaos.org/research/guidelines/PE_guideline.pdf.
      1. Johanson NA, Lachiewicz PF, Lieberman JR, et al. Prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty. J Am Acad Orthop Surg 2009;17:183–196.
      1. Turpie AG, Bauer KA, Eriksson BI, Lassen MR. PENTATHALON 2000 Study Steering Committee. Postoperative fondaparinux versus postoperative enoxaparin for prevention of venous thromboembolism after elective hip-replacement surgery: a randomised double-blind trial. Lancet 2002;359:1721–1726.
      1. Lassen MR, Bauer KA, Eriksson BI, Turpie AG. European Pentasaccharide Elective Surgery Study (EPHESUS) Steering Committee. Postoperative fondaparinux versus preoperative enoxaparin for prevention of venous thromboembolism in elective hip-replacement surgery: a randomised double-blind comparison. Lancet 2002;359:1715–1720.
      1. Tribout B, Colin-Mercier F. New versus established drugs in venous thromboprophylaxis: efficacy and safety considerations related to timing of administration. Am J Cardiovasc Drugs 2007;7:1–15.
      1. Kim HJ. Epidemiology of VTE in orthopaedic patients. In: Yoo MC, Kim HJ, Choi CH, editors. Venous thromboembolism in orthopaedics. Seoul: BMM Korea; 2010. pp. 15-46.
      1. Fujita S, Hirota S, Oda T, Kato Y, Tsukamoto Y, Fuji T. Deep venous thrombosis after total hip or total knee arthroplasty in patients in Japan. Clin Orthop Relat Res 2000;375:168–174.
      1. Wang CJ, Wang JW, Chen LM, Chen HS, Yang BY, Cheng SM. Deep vein thrombosis after total knee arthroplasty. J Formos Med Assoc 2000;99:848–853.
      1. Silbersack Y, Taute BM, Hein W, Podhaisky H. Prevention of deep-vein thrombosis after total hip and knee replacement. Low-molecular-weight heparin in combination with intermittent pneumatic compression. J Bone Joint Surg Br 2004;86:809–812.
      1. Sikorski JM, Hampson WG, Staddon GE. The natural history and aetiology of deep vein thrombosis after total hip replacement. J Bone Joint Surg Br 1981;63:171–177.
      1. Warwick D, Friedman RJ, Agnelli G, et al. Insufficient duration of venous thromboembolism prophylaxis after total hip or knee replacement when compared with the time course of thromboembolic events: findings from the Global Orthopaedic Registry. J Bone Joint Surg Br 2007;89:799–807.
      1. Dahl OE, Gudmundsen TE, Haukeland L. Late occurring clinical deep vein thrombosis in joint-operated patients. Acta Orthop Scand 2000;71:47–50.
      1. Douketis JD, Eikelboom JW, Quinlan DJ, Willan AR, Crowther MA. Short-duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of prospective studies investigating symptomatic outcomes. Arch Intern Med 2002;162:1465–1471.
      1. The Danish Enoxaparin Study Group. Low-molecular-weight heparin (enoxaparin) vs dextran 70. The prevention of postoperative deep vein thrombosis after total hip replacement. Arch Intern Med 1991;151:1621–1624.
    Cited by
    Crossref 6
    Google Scholar 
    MeSH Terms
    Arthroplasty
    Arthroplasty, Replacement, Knee
    Aspirin
    Dalteparin
    Hemorrhage
    Humans
    Incidence
    Knee
    Knee Joint
    Pulmonary Embolism
    Thigh
    Venous Thromboembolism
    Venous Thrombosis
    Metrics
    Share
    Figures
    slide
    slide

    1 / 2

    Tables
    slide
    slide
    slide
    slide
    slide

    1 / 5

    PERMALINK