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23-27 oktober 2006 Vitenskapelige forhandlinger Abstrakt nr: 221 LONG-TERM OCCURRENCE OF VENOUS THROMBOEMBOLISM AFTER MAJOR JOINT SURGERY Dahl OE 1 , Bjørnarå BT, 2 Gudmundsen TE 2 1 Thrombosis Research Institute, London, United Kingdom 2 Buskerud Hospital & University College, Drammen, Norway Background: The current incidence of clinical pulmonary embolism (PE) and deep venous thrombosis (DVT) after major joint surgery remains uncertain. Further, it is unknown whether the risk has changed in the population of interest through the last decade. The risk profile also varies between different surgical groups. Methods: A 13-year prospective registry (1989-2001) of all patients undergoing major hip and knee surgery at a Norwegian hospital was performed. All patients received thromboprophylaxis with low-molecular-weight heparin for about ten days. Patients with suspected PE and DVT underwent objective confirmatory radiological tests. Results: During the study period, 4932 patients underwent major joint surgery. The overall incidence of thromboembolic complications was 2·6% (135/4932). A total of 60 patients (1·2%) developed confirmed PE, while 75 (1·5%) had confirmed DVT. The mean time to readmission for PE was 42 days after total hip replacement (THR), 44 days after total knee replacement (TKR) and 24 days after hip fracture repair (HFR). The mean time to readmission for DVT was 45 days after THR, 31 days after TKR and 47 days after HFR. In patients undergoing elective THR and emergency HFR the cumulative rate of DVT and PE showed parallel increases reaching a plateau after 2-3 months. Following TKR, a more rapid increase in cumulative DVT and PE was observed reaching a plateau after approximately 1 month. The annual incidence of DVT and PE remained stable during the study period. Interpretation: Patients undergoing major joint surgery who receive in-hospital thromboprophylaxis, have an elevated risk of venous thromboembolic complications for at least 2 months. Differences in the timing of DVT and PE development in the THR and HFR groups compared with those undergoing TKR suggests that these patients should be considered separately when determining the optimal thromboprophylactic regimen.
23-27 oktober 2006 Vitenskapelige forhandlinger Abstrakt nr: 222 VASCULAR OUTCOMES FOLLOWING MAJOR JOINT SURGERY Dahl OE 1 , Caprini JA, Colwell CW Jr., Frostick SP, Haas S, Hull RD, Laporte S, Stein PD. 1 Thrombosis Research Institute, London, United Kingdom; 2 Evanston Northwestern Healthcare, Evanston, USA; 3 Scripps Clinic, La Jolla, California, USA.; 4 Royal Liverpool University Hospital, Liverpool, United Kingdom; 5 Technische Universität München, München, Germany; 6 University of Calgary, Calgary, Canada; 7 University Hospital Bellevue, Saint- Etienne, France; 8 St. Joseph Mercy Oakland Hospital, Michigan, USA Background: Major orthopedic surgery is associated with potentially serious arterial and venous vascular complications. Methods: Using electronic databases and investigator contact, randomized and cohort studies reporting overall mortality and fatal vascular events were identified. Where possible, studies reporting high autopsy rates (>60 percent) were examined. Pooled incidences were calculated from eligible studies. Results: Pooled overall mortality and fatal pulmonary embolism (PE) for patients undergoing elective total hip replacement (THR), total knee replacement (TKR) and hip fracture repair (HFR) with and without prophylaxis are shown in the table below. Outcomes No Prophylaxis - % (95% CI) Prophylaxis - % (95% CI) Mortality Fatal PE Mortality Fatal PE Autopsy Studies THR and TKR 0.44 (0.02- 0.87) 0.43 (0.01- 0.85) - - HFR Cohort Studies 15.9 (14.5- 17.3) 1.9 (1.4-2.4) 8.5 (7.3-9.7) 1.0 (0.6-1.5) THR and 0.93 (0.57- 0.36 (0.14- 0.57 (0.51- 0.18 (0.14- TKR 1.29) 0.59) 0.62) 0.21) HFR - - 3.2 (2.8-3.6) 0.30 (0-0.61) Vascular events contributed towards approximately 50 percent of all deaths with similar proportions due to ischaemic heart disease, cardiac failure and PE. Conclusion: Although prophylaxis results in a reduction in overall mortality and fatal PE, vascular events continue to be a common cause of mortality.
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