Epidemiology of venous thromboembolism in Asian patients undergoing major orthopedic surgery without thromboprophylaxis. The SMART Study

Authors

  • A. LEIZOROVICZ,

    1. Service de Pharmacologie Clinique, EA 3736, Université de Lyon 1, Lyon, France; *Department of Medicine HHSC-General Division, Hamilton, Ontario, Canada; †Academic Department of Surgery, Guy's, King's & St Thomas' School of Medicine, London, UK; ‡The Chinese University of Hong Kong, Hong Kong, China; §Kyung Hee University Hospital, Seoul, South Korea; and ¶Philippines General Hospital, Philippines
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  • A. G. G. TURPIE,

    1. Service de Pharmacologie Clinique, EA 3736, Université de Lyon 1, Lyon, France; *Department of Medicine HHSC-General Division, Hamilton, Ontario, Canada; †Academic Department of Surgery, Guy's, King's & St Thomas' School of Medicine, London, UK; ‡The Chinese University of Hong Kong, Hong Kong, China; §Kyung Hee University Hospital, Seoul, South Korea; and ¶Philippines General Hospital, Philippines
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  • A. T. COHEN,

    1. Service de Pharmacologie Clinique, EA 3736, Université de Lyon 1, Lyon, France; *Department of Medicine HHSC-General Division, Hamilton, Ontario, Canada; †Academic Department of Surgery, Guy's, King's & St Thomas' School of Medicine, London, UK; ‡The Chinese University of Hong Kong, Hong Kong, China; §Kyung Hee University Hospital, Seoul, South Korea; and ¶Philippines General Hospital, Philippines
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  • L. WONG,

    1. Service de Pharmacologie Clinique, EA 3736, Université de Lyon 1, Lyon, France; *Department of Medicine HHSC-General Division, Hamilton, Ontario, Canada; †Academic Department of Surgery, Guy's, King's & St Thomas' School of Medicine, London, UK; ‡The Chinese University of Hong Kong, Hong Kong, China; §Kyung Hee University Hospital, Seoul, South Korea; and ¶Philippines General Hospital, Philippines
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  • M. C. YOO,

    1. Service de Pharmacologie Clinique, EA 3736, Université de Lyon 1, Lyon, France; *Department of Medicine HHSC-General Division, Hamilton, Ontario, Canada; †Academic Department of Surgery, Guy's, King's & St Thomas' School of Medicine, London, UK; ‡The Chinese University of Hong Kong, Hong Kong, China; §Kyung Hee University Hospital, Seoul, South Korea; and ¶Philippines General Hospital, Philippines
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  • A. DANS,

    1. Service de Pharmacologie Clinique, EA 3736, Université de Lyon 1, Lyon, France; *Department of Medicine HHSC-General Division, Hamilton, Ontario, Canada; †Academic Department of Surgery, Guy's, King's & St Thomas' School of Medicine, London, UK; ‡The Chinese University of Hong Kong, Hong Kong, China; §Kyung Hee University Hospital, Seoul, South Korea; and ¶Philippines General Hospital, Philippines
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  • FOR THE SMART STUDY GROUP

    1. Service de Pharmacologie Clinique, EA 3736, Université de Lyon 1, Lyon, France; *Department of Medicine HHSC-General Division, Hamilton, Ontario, Canada; †Academic Department of Surgery, Guy's, King's & St Thomas' School of Medicine, London, UK; ‡The Chinese University of Hong Kong, Hong Kong, China; §Kyung Hee University Hospital, Seoul, South Korea; and ¶Philippines General Hospital, Philippines
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    • **

      Committees and Investigators participating in the SMART (Surgical Multinational Asian Registry in Thrombosis) Study are listed in the Appendix.


A. Leizorovicz, Service de Pharmacologie Clinique, EA 3736, Faculté R.T.H. Laennec, Rue Guillaume Paradin, BP 8071 69376, Lyon cedex 08, France.
Tel.: +33 4 7878 5757; fax: +33 4 7877 6917; e-mail: al@upcl.univ-lyon1.fr

Abstract

Summary. Background: In Asian patients undergoing surgery, the incidence of venous thromboembolism (VTE) is thought to be low relative to Western patients, and the routine use of thromboprophylaxis is controversial. Objectives: The aim of this work was to study the epidemiology of VTE in Asian patients undergoing orthopedic surgery without thromboprophylaxis. Patients and methods: We performed a prospective observational study of a cohort of consecutive Asian patients hospitalized for total hip or knee replacement or hip fracture surgery without thromboprophylaxis. The primary study outcome was the incidence of the composite of symptomatic VTE or sudden death at hospital discharge. This outcome was also assessed at 1 month's follow-up. Results: Between April 2001 and July 2002, 2420 patients were enrolled. Median age was 68 years and the median duration of hospital stay was 13 days. The rate of symptomatic VTE or sudden death as notified by investigators was 2.3%[55 patients, 99% confidence interval (CI) 1.6, 3.2] and 1.2% (28 patients, 99% CI 0.7, 1.8) after adjudication by an independent committee. Chronic heart failure, varicose veins and a history of VTE were independent risk factors (P < 0.05) for the occurrence of the primary endpoint. At 1 month's follow-up, the incidence of adjudicated symptomatic VTE or sudden death was 1.5% (35/2264 patients). Conclusion: In Asian patients, the incidence of symptomatic VTE after major orthopedic surgery is not low, consistent with the rates observed in Western countries. The use of thromboprophylaxis should be considered in Asian patients undergoing such high-risk surgical procedures.

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