Symptomatic venous thromboembolism after total knee replacement.
Chemical prophylaxis is known to reduce the venographic prevalence of deep-vein thrombosis (DVT) after total knee replacement (TKR), but it is uncertain whether this affects the incidence of symptoms.
Further analysis depends on the basic epidemiology of thromboembolic symptoms.
We therefore studied the pattern of such symptoms in a consecutive series of 1000 patients with primary TKR, with particular reference to risk factors and prophylaxis.
We reviewed all the clinical records and contacted all the patients individually, noting risk factors, prophylaxis, symptomatic pulmonary embolus (PE) or DVT and its timing, death and its causes, and all complications.
All the patients wore antiembolism stockings, 83% had regional anaesthesia and 33.9% had chemical prophylaxis.
One patient died from PE on the day of surgery, having had no prophylaxis giving a rate of 0.1% (95% CI 0.003% to 0.56%). Symptomatic, radiologically confirmed thromboembolism (VTE) was common with a rate of 10.6% (95% CI 8.7% to 12.5%). There was a similar incidence of VTE in those with and without chemical prophylaxis (10.1% v 10.5%, RR 0.96, NS).
VTE was more common in patients with risk factors (15.1% v 9.5%, RR 1.59, p=0.02) and tended to occur earlier in this group (median day of onset 5 v 7, p=0.01).
Chemical prophylaxis did not reduce the frequency of symptomatic thromboembolism in either those with risk factors (RR 0.81, p=0.5) or those without them (RR 0.94, p=0.8). (...)
Mots-clés Pascal : Prothèse, Total, Genou, Thrombose, Veine profonde, Complication, Embolie pulmonaire, Postopératoire, Symptomatologie, Epidémiologie, Incidence, Etude longitudinale, Court terme, Homme, Membre inférieur, Chirurgie orthopédique, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Veine pathologie, Appareil respiratoire pathologie
Mots-clés Pascal anglais : Prosthesis, Total, Knee, Thrombosis, Deep vein, Complication, Pulmonary embolism, Postoperative, Symptomatology, Epidemiology, Incidence, Follow up study, Short term, Human, Lower limb, Orthopedic surgery, Cardiovascular disease, Vascular disease, Venous disease, Respiratory disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0489277
Code Inist : 002B25I. Création : 03/02/1998.