Venous Thromboembolism in Patients Having Knee Replacement and Receiving Thromboprophylaxis

Pedersen, Alma B.; Mehnert, Frank; Johnsen, Soren P.; Husted, Steen; Sorensen, Henrik T.
July 2011
Journal of Bone & Joint Surgery, American Volume;7/20/2011, Vol. 93-A Issue 14, p1281
Academic Journal
Background: We examined the rate of venous thromboernbolism, as well as changes overtime, in a population-based cohort of patients who underwent knee arthroplasty. Methods: Using medical databases, we identified all patients who underwent primary knee arthroplasties with phar- macological thromboprophylaxis performed in Denmark from 1997 to 2007. The outcome was hospitalization with symptomatic venous thromboernbolism within ninety days of surgery. We examined several potential patient and surgery- related predictors for venous thromboembolism using Cox regression analyses. Results: The overall rate of hospitalization for venous thromboembolism among 37,223 patients within ninety days after primary knee arthroplasty was 1.2% (441 patients) at a median of fifteen days. The rate of hospitalization was 0.9% (323 patients) for deep venous thrombosis and 0.3% (127 patients) for pulmonary embolism, with nine patients who had both. The rate of venous thromboembolism increased during the ten-year study period. Patients with a high score on the Charison comorbidity index had an increased relative risk for venous thromboembolism compared with patients with a low score (adjusted relative risk = 1.73; 95% confidence interval, 1.24 to 2.41). Patients with a history of cardiovascular disease or a previous venous thromboembolism had an increased risk for postoperative venous thromboembollsm compared with patients without these conditions. Surgery-related factors were not predictors for venous thromboembolism. Conclusions: Despite pharmacological thromboprophylaxis, patients undergoing knee arthroplasty remain susceptible for venous thromboembolisni events after surgery. Future efforts should focus on the improvement of prophylaxis fol- lowing hospital discharge, particularly among elderly patients and those with a history of cardiovascular diseases or previous venous thromboembolism. Level of Evidence: Prognostic LevelII. See Instructions to Authors fora complete description of levels of evidence.


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