Venous Thromboembolism despite Ongoing Prophylaxis after Fast-Track Hip and Knee Arthroplasty: A Prospective Multicenter Study of 34,397 Procedures
21 June 2019
14 July 2019
06 October 2019 (online)
Introduction Venous thromboembolism (VTE) is a serious complication to total hip and knee arthroplasty (THA/TKA). However, recent publications found low 90-day incidences of VTE with in-hospital only thromboprophylaxis after fast-track THA and TKA, but with a subgroup with VTE despite thromboprophylaxis.
Objectives We aimed to investigate in detail the incidence and risk for VTE despite ongoing thromboprophylaxis after fast-track THA and TKA.
Materials and Methods This is a prospective unselected multicenter cohort from January 2010 to August 2017. Data on preoperative characteristics were entered into the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement database (www.FTHK.dk). Length of stay (LOS) and complete 90-day follow-up was obtained from the Danish National Patient Registry and review of medical records. Patients with preoperative use of potent anticoagulants were excluded.
Results Of 34,397 procedures, 32 (0.09%, 22.4% of all VTE) had VTE after median 2 (interquartile range: 2–4) days despite ongoing thromboprophylaxis. Twenty-nine (2.1% of LOS > 5 days) occurred with LOS > 5 days and 3 during primary admission with LOS ≤ 5 days. Note that 78% of VTEs despite ongoing thromboprophylaxis occurred without any identifiable pre-VTE complication. Risk factors were age from 81 to 85 years (odds ratio [OR] 6.3 [95% confidence interval: 1.8–22.4], p = 0.005), body mass index (BMI) < 18.5 (OR 11.1 [1.1–109.2], p = 0.040), BMI 35 to 40 (OR 5.1 [1.0–26.2], p = 0.050), and BMI ≥ 40 (OR 21.8 [4.6–103.6], p < 0.001).
Conclusion VTE after fast-track THA/TKA occurred after median 2 days in 0.09% (22% of all VTE) despite ongoing thromboprophylaxis. Further investigation of this “high-risk” population might help to improve the optimal choice for patient-specific thromboprophylaxis to further reduce incidence of postoperative VTE.
* Members of the Lundbeck Foundation Centre for Fast-track Hip and Knee collaborative group: Frank Madsen, MD, Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark. Torben B. Hansen, Prof., MD, PhD, Department of Orthopedics, Regional Hospital Holstebro and University of Aarhus, Holstebro, Denmark. Kirill Gromov, MD, PhD, Department of Orthopedics, Hvidovre Hospital; Hvidovre, Denmark. Mogens Laursen, Ass. Prof., MD, PhD, Aalborg University Hospital Northern Orthopaedic Division, Aalborg, Denmark. Lars T. Hansen, MD, Department of Orthopedics, Sydvestjysk Hospital Esbjerg/Grindsted, Grindsted, Denmark; Per Kjærsgaard-Andersen, Ass.Prof., MD, Department of Orthopedics, Vejle Hospital, Vejle, Denmark. Soren Solgaard, MD, DMSci, Department of Orthopedics, Gentofte University Hospital, Copenhagen, Denmark. Niels Harry Krarup, MD, Department of Orthopedics, Viborg Hospital, Viborg, Denmark. Jens Bagger, MD, Department of Orthopaedic Surgery, Copenhagen University Hospital Bispebjerg, Copenhagen NV, Denmark.
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