The incidence of venous thromboembolism is low when risk stratification-based thromboprophylaxis is used after fast-track hip and knee arthroplasty
Abstract Background The optimal length of thromboprophylaxis after total hip or knee arthroplasty (THA and TKA) is unknown. Fast-track protocols have improved patient care and led to shorter immobilization and length of stay (LOS) after THA and TKA, thereby diminishing venous thromboembolism (VTE) r...
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BMC
2024-12-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-024-08256-6 |
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| author | Annette M Moisander Konsta Pamilo Jukka Huopio Hannu Kautiainen Anne Kuitunen Juha Paloneva |
| author_facet | Annette M Moisander Konsta Pamilo Jukka Huopio Hannu Kautiainen Anne Kuitunen Juha Paloneva |
| author_sort | Annette M Moisander |
| collection | DOAJ |
| description | Abstract Background The optimal length of thromboprophylaxis after total hip or knee arthroplasty (THA and TKA) is unknown. Fast-track protocols have improved patient care and led to shorter immobilization and length of stay (LOS) after THA and TKA, thereby diminishing venous thromboembolism (VTE) risk. Here, we investigated risk stratification-based thromboprophylaxis after fast-track THA and TKA. Methods A retrospective register study was conducted in two Finnish hospitals using a fast-track protocol for THA and TKA. These hospitals use risk stratification-based planning of thromboprophylaxis, including risk evaluation of patients’ personal VTE risk. Patients at low risk received thromboprophylaxis solely during hospitalization, provided this lasted five days or less. All VTEs and clinically relevant bleedings were obtained from Finnish hospital discharge registers between 1 January 2020 and 31 December 2021 to determine VTE incidences and clinically relevant bleedings 90 days after surgery. Results During the study period 3 713 arthroplasties were performed (1 636 THAs and 2 077 TKAs). The 90-day incidence of VTE was 0.7% (CI 0.4 to 0.9), and 25 VTEs occurred within 90 days of surgery. These VTEs comprised 12 pulmonary embolisms and 13 deep vein thromboses, none of which was fatal. The incidence of clinically relevant bleedings (n = 57) within 90 days of surgery was 1.5% (CI 1.1 to 1.9). One intracranial bleeding was fatal. The bleedings typically occurred at the operational site. Conclusion Risk stratification-based thromboprophylaxis appears safe for fast-track THA and TKA patients as the incidences of VTEs and clinically relevant bleedings were low. |
| format | Article |
| id | doaj-art-a9d9d04071664c968fb5fcdf6021989b |
| institution | Kabale University |
| issn | 1471-2474 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj-art-a9d9d04071664c968fb5fcdf6021989b2025-01-05T12:04:47ZengBMCBMC Musculoskeletal Disorders1471-24742024-12-012511710.1186/s12891-024-08256-6The incidence of venous thromboembolism is low when risk stratification-based thromboprophylaxis is used after fast-track hip and knee arthroplastyAnnette M Moisander0Konsta Pamilo1Jukka Huopio2Hannu Kautiainen3Anne Kuitunen4Juha Paloneva5Department of Anesthesia and intensive Care, Hospital Nova of Central Finland, Wellbeing Services County of Central FinlandCoxa Hospital for Joint Replacement, Wellbeing Services County of PirkanmaaCoxa Hospital for Joint Replacement, Wellbeing Services County of PirkanmaaPrimary Health Care Unit, University of Eastern Finland, Folkhälsan Research CenterDepartment of Intensive Care, University of Tampere, Tampere University Hospital, Wellbeing Services County of PirkanmaaDepartment of Surgery, Hospital Nova of Central Finland, Wellbeing Services County of Central Finland, Jyväskylä, University of Eastern FinlandAbstract Background The optimal length of thromboprophylaxis after total hip or knee arthroplasty (THA and TKA) is unknown. Fast-track protocols have improved patient care and led to shorter immobilization and length of stay (LOS) after THA and TKA, thereby diminishing venous thromboembolism (VTE) risk. Here, we investigated risk stratification-based thromboprophylaxis after fast-track THA and TKA. Methods A retrospective register study was conducted in two Finnish hospitals using a fast-track protocol for THA and TKA. These hospitals use risk stratification-based planning of thromboprophylaxis, including risk evaluation of patients’ personal VTE risk. Patients at low risk received thromboprophylaxis solely during hospitalization, provided this lasted five days or less. All VTEs and clinically relevant bleedings were obtained from Finnish hospital discharge registers between 1 January 2020 and 31 December 2021 to determine VTE incidences and clinically relevant bleedings 90 days after surgery. Results During the study period 3 713 arthroplasties were performed (1 636 THAs and 2 077 TKAs). The 90-day incidence of VTE was 0.7% (CI 0.4 to 0.9), and 25 VTEs occurred within 90 days of surgery. These VTEs comprised 12 pulmonary embolisms and 13 deep vein thromboses, none of which was fatal. The incidence of clinically relevant bleedings (n = 57) within 90 days of surgery was 1.5% (CI 1.1 to 1.9). One intracranial bleeding was fatal. The bleedings typically occurred at the operational site. Conclusion Risk stratification-based thromboprophylaxis appears safe for fast-track THA and TKA patients as the incidences of VTEs and clinically relevant bleedings were low.https://doi.org/10.1186/s12891-024-08256-6Risk stratificationThromboprophylaxisVenous thromboembolismFast-trackTotal hip arthroplastyTotal knee arthroplasty |
| spellingShingle | Annette M Moisander Konsta Pamilo Jukka Huopio Hannu Kautiainen Anne Kuitunen Juha Paloneva The incidence of venous thromboembolism is low when risk stratification-based thromboprophylaxis is used after fast-track hip and knee arthroplasty BMC Musculoskeletal Disorders Risk stratification Thromboprophylaxis Venous thromboembolism Fast-track Total hip arthroplasty Total knee arthroplasty |
| title | The incidence of venous thromboembolism is low when risk stratification-based thromboprophylaxis is used after fast-track hip and knee arthroplasty |
| title_full | The incidence of venous thromboembolism is low when risk stratification-based thromboprophylaxis is used after fast-track hip and knee arthroplasty |
| title_fullStr | The incidence of venous thromboembolism is low when risk stratification-based thromboprophylaxis is used after fast-track hip and knee arthroplasty |
| title_full_unstemmed | The incidence of venous thromboembolism is low when risk stratification-based thromboprophylaxis is used after fast-track hip and knee arthroplasty |
| title_short | The incidence of venous thromboembolism is low when risk stratification-based thromboprophylaxis is used after fast-track hip and knee arthroplasty |
| title_sort | incidence of venous thromboembolism is low when risk stratification based thromboprophylaxis is used after fast track hip and knee arthroplasty |
| topic | Risk stratification Thromboprophylaxis Venous thromboembolism Fast-track Total hip arthroplasty Total knee arthroplasty |
| url | https://doi.org/10.1186/s12891-024-08256-6 |
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