Thromboseprophylaxe in der Knieendoprothetik

Zusammenfassung

Fragestellung: Die symptomatische tiefe Beinvenenthrombose ist mit einer Inzidenz von 4 - 5 % unter medikamentöser Thromboseprophylaxe eine ernsthafte Komplikation nach endoprothetischem Ersatz des Kniegelenks. Ziel dieser Arbeit ist die Erhebung aktuellen Prophylaxeverhaltens in der Knieendoprothetik an deutschen Kliniken. Material und Methode: In einer deutschlandweiten Umfrage wurden Fragebogen mit Items zur Thromboseprophylaxe in der Knieendoprothetik an 470 orthopädische und unfallchirurgische Kliniken versandt. Ergebnisse: 98 % der Kliniken führen eine Prophylaxe mit niedermolekularem Heparin, 2 % mit unfraktioniertem Heparin durch. Die niedermolekularen Heparine werden in 48 % der Kliniken in Standarddosierung, in 44 % gewichtsadaptiert appliziert. Erstgabe ist in 82 % der Kliniken der Abend vor der Operation. Im Mittel wird die TP für 4,7 Wochen durchgeführt. 96 % der Kliniken verwenden zusätzlich Antithrombosestrümpfe. Schlussfolgerung: Art und Umfang der TP bei endoprothetischem Kniegelenksersatz stimmen an der überwiegenden Zahl der befragten Kliniken mit den Leitlinienempfehlungen überein.

Abstract

Introduction: Symptomatic deep vein thrombosis is a serious complication after total knee arthroplasty, with a risk of about 4 - 5 % despite prevention with herparin. Aim of the current study was to find out about the actual status of thrombosis prophylaxis in Germany after total knee replacement. Material and Methods: In a countrywide survey 470 German trauma and orthopaedic surgery departments were asked about their prophylactic procedures addressing deep vein thrombosis after total knee replacement. Results: 98 % perform prevention of thrombosis with low-molecular-weight heparin, 2 % use unfractioned heparin. Low-molecular-weight heparin is applicated in standard doses in 48 % and in 44 % according to patient’s weight. In 82 % the prophylaxis is begun the night before surgery. The therapy is carried out for 4.7 weeks in mean. 96 % use graduated compressions stocking as additional therapeutic option. Conclusion: Our survey shows that most of the surgeons perform prevention of deep vein thrombosis according to the official guidelines.

Schlüsselwörter

Knieendoprothetik - Thromboseprophylaxe - tiefe Venenthrombose - nationale Umfrage

Key words

Total knee replacement - prevention of deep vein thrombosis - deep vein thrombosis - national survey

Literatur

• 1 Anderson F A, Hirsh J. Temporal trends in prevention of venous thromboembolism following primary total hip or knee arthroplasty 1996 - 2001: findings from the Hip and Knee Registry.  Chest. 2003;  124 (6 Suppl) 349-356
• 2 AWMF-Online: Leitlinie zur Thromboembolie-Prophylaxe: AWMF-Leitlinien-Register, Nr. 037/003, http://www.uni-duesseldorf.de/AWMF/awmf-fr2.htm. 
• 3 Bäthis H, Tingart M, Perlick L. et al . Stellenwert von Endoprothetik und Umstellungsosteotomien bei Gonarthrose. Ergebnisse einer Umfrage an Unfallchirurgischen und Orthopädischen Kliniken.  Z Orthop Ihre Grenzgeb. 2005;  143 (1) 19-24
• 4 Best A, Williams J S. Graded compression stockings in elective orthopaedic surgery. An assessment of the in vivo performance of commercially available stockings in patients having hip and knee arthroplasty.  J Bone Joint Surg Br. 2000;  82 (1) 116-118
• 5 Blanchard J, Meuwly J Y, Leyvraz P F. Prevention of deep-vein thrombosis after knee replacement: randomised comparison between a low-molecular-weight heparin (nadroparin) and mechanical prophylaxis with a foot-pump system.  J Bone Joint Surg (Br). 1999;  81-B 654-659
• 6 Brookenthal K R, Freedman K B. A meta-analysis of thromboembolic prophylaxis in total knee arthroplasty.  J Arthroplasty. 2001;  16 (3) 293-300
• 7 Browse N L, Burnand K G, Irvine A T. Diseases of the veins. Arnold N London; Second Edition 1999
• 8 Cohen A T, Khushal A. Extended thromboprophylaxis following lower limb arthroplasty: what do the clinical trials mean?.  Haemostasis. 2000;  2 88-94
• 9 Colwell C W. Low molecular weight heparin prophylaxis in total knee arthroplasty: the answer.  Clin Orthop. 2001;  392 245-248
• 10 Colwell C W. Managing thromboembolic risk in hip and knee arthroplasty: state of the art.  Orthopedics. 2003;  26 (2 Suppl) 231-236
• 11 Cordell-Smith J A, Williams S C. Lower limb arthroplasty complicated by deep venous thrombosis. Prevalence and subjective outcome.  J Bone Joint Surg Br. 2004;  86 (1) 99-101
• 12 Douketis J D, Eikelboom J W. 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 (13) 1465-1471
• 13 Eikelboom J W, Quinlan D J. Extended-duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of the randomised trials.  Lancet. 2001;  358 (9275) 9-15
• 14 Geerts W H, Heit J A, Clagett G P. Prevention of venous thromboembolism.  Chest. 2001;  119 (Suppl 1) 132-175
• 15 Geerts W H, Pineo G F, Heit J A. et al . Prevention of venous thromboembolism: the 7th ACCP conference on antithrombotic and thrombolytic therapy.  Chest. 2004;  126 (Suppl 3) 338S-400S
• 16 Gill S G, Mill S D, Joshi A B. Mortality following primary total knee arthroplasty.  J Bone Joint Surg. 2003;  85A 432-435
• 17 Grifka J, Haas S, Hovy L. et al . An update on thrombosis prophylaxis in orthopaedic and accident surgery.  Orthopade. 2004;  33 (7) 762-773
• 18 Haas S. Prevention, diagnosis and therapy of thromboses in orthopedic and trauma surgery.  Orthopade. 1997;  26 1062-1074
• 19 Nicolaides A N, Breddin H K, Fareed J. et al . Prevention of venous thromboembolism. International Consensus Statement. Guidelines compiled in accordance with the scientific evidence.  Int Angiol. 2001;  20 (1) 1-37
• 20 Patsch H, Blättler W. Leitlinien zur Thromboembolie-Prophylaxe.  Phlebol. 1996;  25 261-266
• 21 Patsch H, Blättler W. Guidelines for thromboembolic prophylaxis: revised version.  Phlebologie. 2000;  29 106-113
• 22 Schellong S, Hesselschwerdt H J, Paar W D. et al . Rates of proximal deep vein thrombosis as assessed by compression ultrasonography in patients receiving prolonged thromboprophylaxis with low molecular weight heparin after major orthopaedic surgery.  Thromb Haemost. 2005;  94 (3) 532-536
• 23 Schwenk W, Neudecker J, Raue W. et al . Fast-track” rehabilitation after rectal cancer resection.  Int J Colorectal Dis. 2005;  9 1-12
• 24 Silbersack Y, Taute B M, Hein W. et al . 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
• 25 Verstraete M, Prentice C RM, Samama M. A European view on the North. American fifth consensus on antithrombotic therapy.  Chest. 2000;  117 1755-1770
• 26 Warwick D, Harrison J, Glew D. Comparisn 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, randomised trial.  J Bone Joint Surg (Am). 1998;  80 1158-1166