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Universal pharmacological thromboprophylaxis for total knee arthroplasty may not be necessary in low-risk populations: a nationwide study in Taiwan

  1. C.-H. LEE1,2,
  2. C.-L. CHENG2,
  3. C.-H. CHANG2,
  4. Y.-H. KAO YANG2,
  5. L.-J. LIN1,2,
  6. T.-C. LIN2,
  7. C.-Y. YANG3

Article first published online: 4 JAN 2012

DOI: 10.1111/j.1538-7836.2011.04555.x

Issue

Journal of Thrombosis and Haemostasis

Journal of Thrombosis and Haemostasis

Volume 10, Issue 1, pages 56–63, January 2012

Additional Information

How to Cite

LEE, C.-H., CHENG, C.-L., CHANG, C.-H., KAO YANG, Y.-H., LIN, L.-J., LIN, T.-C. and YANG, C.-Y. (2012), Universal pharmacological thromboprophylaxis for total knee arthroplasty may not be necessary in low-risk populations: a nationwide study in Taiwan. Journal of Thrombosis and Haemostasis, 10: 56–63. doi: 10.1111/j.1538-7836.2011.04555.x

Author Information

  1. 1

    Department of Internal Medicine, National Cheng Kung University Hospital, Tainan

  2. 2

    Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan

  3. 3

    Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan

*Yea-Huei Kao Yang, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, University Road, Tainan, Taiwan. Tel.: +886 6 2353535 ext. 5688; fax: +886 6 2373149. E-mail:yhkao@mail.ncku.edu.tw.

Publication History

  1. Issue published online: 4 JAN 2012
  2. Article first published online: 4 JAN 2012
  3. Accepted manuscript online: 8 NOV 2011 10:03AM EST
  4. Received 3 May 2011, accepted 3 November 2011

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Keywords:

  • deep vein thrombosis;
  • epidemiology;
  • knee replacement surgery;
  • pulmonary embolism;
  • thromboprophylaxis;
  • venous thromboembolism

Summary. Background: Thromboprophylaxis should be universally administered in major orthopedic surgery. However, epidemiology of venous thromboembolism (VTE) following major knee surgery in Asia is scarce. Objective: To describe the use of thromboprophylaxis and calculate the incidence and risk factors of symptomatic VTE following major knee surgery in Taiwan. Methods: We used Taiwan’s National Health Insurance Research Database to retrospectively identify patients (≧45 years) who underwent major knee surgery from 1998 to 2007 and collected the medical records within 3 months after the discharge. Logistic regression analysis was used to determine the risk factors of symptomatic VTE after the surgery. Results: We identified 113 844 patients (mean age, 69.0 ± 7.7 years; female, 75.2%) receiving major knee arthroplasties. The mean length of stay was 9.1 ± 3.3 days. The overall pharmacological thromboprophylaxis rate was 2.2%. The 3-month cumulative incidence of procedure-related symptomatic VTE was 0.46% (95% CI, 0.42–0.50%). The median time to the first post-operation VTE was 7 days, with 85.4% occurring within 2 weeks after the discharge. Logistic regression analysis showed that previous VTE, malignancy, heart failure and neurologic disorder with extremity paralysis or pararesis were independent risk factors (P < 0.05) for symptomatic VTE following major knee arthroplasties. Conclusions: The thromboprophylaxis rate is low, which may be due to the very low incidence of symptomatic VTE after the surgery in Taiwan. Most symptomatic VTE occurred within 2 weeks after the surgery. Universal thromboprophylaxis for knee arthroplasties may not be necessary in Taiwan, but it should be considered in some high-risk populations.

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