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

Jin-Kyu Lee; Kyu-Sung Chung; Seung-Wook Baek; Choong-Hyeok Choi

doi:10.4055/jkoa.2012.47.2.86

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Lee, Chung, Baek, and Choi: The Prophylaxis of Venous Thromboembolism in Korean Patients with Total Knee Replacement Arthroplasty

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2012; 47(2): 86-95.

Published online: 30 April 2012

DOI: https://doi.org/10.4055/jkoa.2012.47.2.86

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., 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, chhchoi@hanyang.ac.kr

Received 28 April 2011 Revised 13 July 2011 Accepted 21 November 2011

(open-access):

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 and Tables

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.

Table 1

Baseline Demographics and Clinical Characteristics of Population

^*Dalteparin-aspirin; ^†Aspirin; ^‡Dalteparin; ^§Fisher exact test; ^//One-Way ANOVA test; ^¶Chi-square test; CI, confidence interval; BMI, body mass index; TKA, total knee arthroplasty; OA, osteoarthritis; RA, rheumatoid arthritis; SLE, systemic lupus erythematosus; ^**Scorpio (Stryker Orthopedics, Mahwah, NJ, USA); ^††Nexgen LPS (Zimmer, Warsaw, IN, USA); ^‡‡PFC (Johnson & Johnson, Raynham, MA, USA).

Table 2

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

^*Dalteparin-aspirin; ^†Aspirin; ^‡Dalteparin; ^§Fisher exact test. TKA, total knee arthroplasty; CI, confidence interval; DVT, deep vein thrombosis; PE, pulmonary emblism.

Table 3

Comparisons of Drainage Amount

^*Dalteparin-aspirin; ^†Aspirin; ^‡Dalteparin; ^∥One-Way ANOVA test.

Table 4

Hemorrhage according to Treatment Regimen

^*Dalteparin-aspirin; ^†Aspirin; ^‡Dalteparin; ^§Fisher exact test. CI, confidence interval.

Table 5

Comparison of Clinical Outcomes

^*Dalteparin-aspirin; ^†Aspirin; ^‡Dalteparin; ^§Fisher exact test; ^∥One-Way ANOVA test. CI, confidence interval; Δ P thigh (cm), Postoperative circumference of thigh on 10 cm above knee - preoperative circumference of thigh on 10 cm above knee.

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