This article is more than 5 years old. Information may no longer be current.
Danish hip arthroplasty data show that thromboembolic events occurred on average 22 days following surgery
Patients with comorbidities such as cardiovascular disease had much higher VTE rates.
Click Here to Manage Email Alerts
Introduction
Most of the surgeons performing joint replacements are always concerned about the possibility of venous thromboembolic (VTE) problems developing in one of their patients. Even though it is a rare occurrence, the potential of a fatal embolus is a constant source of concern.
We want to give our patients a level of prophylaxis without that therapy resulting in an increase in the potential complications related to increased bleeding. When I read Alma B. Pedersen, MD, PhD’s, report on 67,000 primary hip replacements from the Danish Hip Arthroplasty Registry, it made me revaluate the length of time I was encouraging prophylaxis in my patients. I subsequently asked her to respond to my 4 Questions this month, specifically with the idea of stimulating you to look at length of time you use VTE prophylaxis in your patients. I realize that different lengths of hospitalization and rapid rehabilitation may make a difference and impact this data; however, this is still good information to compare with other experiences reported on large numbers of patients. Since most of the primary hip replacements are done by surgeons doing less then 50 to 100 per year, it is hard to have enough experience from our patients to truly give a representation of the overall risk factors. I hope that Dr. Pedersen’s publication will stimulate you to think further about your current prophylaxis.
— Douglas W. Jackson, MD
Chief Medical Editor
Douglas W. Jackson, MD: You recently reported upon the 67,469 primary total hip replacements in the Danish Hip Arthroplasty Registry. What was your incidence and the timing of your VTE problems?
Alma B. Pedersen, MD, PhD: The incidence of VTE within 90 days was 1%, and the events occurred on average after 22 days. The incidence increased slowly in the period 1995 to 2006.
Jackson: What risk factors in patients did you identify for thromboembolic phenomenon?
|
|
Pedersen: We showed that patients with several comorbidities prior to surgery, in particular patients with cardiovascular diseases and VTE events, had a much higher risk of sustaining a VTE event after surgery than patients without these diseases. Previously hospitalization with diseases such as dementia, chronic pulmonary disease, connective tissue disease, and ulcers increased the risk of VTE after surgery as well. We could also see that patients with diagnosed rheumatoid arthritis had lower risk of sustaining VTE after hip replacement than the patient undergoing standard hip replacement who had osteoarthritis. Both younger and older patients could sustain VTE after hip replacement.
Jackson: What was your median VTE rate of re-hospitalization within 90 days following hip replacement?
Pedersen: The median time for VTE within 90 days was 22 days, which extent beyond average length of hospitalization for hip replacement surgery.
Jackson: With shorter hospitalizations, less time in bed and mechanical approaches, what is your current thinking on deep vein thrombosis (DVT) prophylaxis?
Pedersen: Shorter hospitalization for surgery should decrease the VTE risk, as we assume that patient is more active and mobile. On the other hand, we have to make sure that every patient takes the recommended pharmacological thromboprophylaxis of at least 4 weeks after surgery to avoid potential VTE. Based on questionnaires sent to all orthopedic departments in Denmark, we could see the pattern of giving pharmacological thromboprophylaxis during hospitalization only, which could be dangerous for the patient in the light of short hospitalization.
Reference:
- Pedersen, AB, et al. Risk factors for venous thromboembolism in patients undergoing total hip replacement and receiving routine thromboprophylaxis. J Bone Joint Surgery (Am).2010;92(12):2156-2164.
- Alma B. Pedersen, MD, PhD, is a staff specialist at the Department of Clinical Epidemiology, Competence Centre North, Aarhus Universityhospital Science Center Skejby, Olof Palmes Alle 43-45, 8200 Aarhus N; 45 8942 4815-4061 6378; e-mail: abp@dce.au.dk.
- Disclosure: Pedersen has no relevant financial disclosure.
