J Korean Orthop Assoc.  2012 Apr;47(2):86-95. 10.4055/jkoa.2012.47.2.86.

The Prophylaxis of Venous Thromboembolism in Korean Patients with Total Knee Replacement Arthroplasty

Affiliations
  • 1Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, Korea. chhchoi@hanyang.ac.kr

Abstract

PURPOSE
To evaluate the effects and problems of venous thromboembolism (VTE) prophylaxis with a reduced dosage and administration period in Korean total knee arthroplasty (TKA) patients.
MATERIALS AND METHODS
We analyzed 135 consecutive TKA patients with three different VTE prophylaxis regimens. Group dalteparin-aspirin (DA) injected dalteparin for the first 2 days, followed by taking aspirin for the next 5 days, Group aspirin (A) was on aspirin and Group dalteparin (D) on dalteparin 7 days postoperatively. We evaluated the incidence of VTE and safety among the 3 groups.
RESULTS
Symptomatic deep vein thrombosis was detected in 4 cases (Group DA: 2, Group A: 1, Group D: 1). Pulmonary embolism (PE) was found in 1 case in each group with no fatal PE. Although no major bleeding complications were seen, minor bleeding incidents were detected in 14 cases (Group DA: 2, Group A: 1, Group D: 11), which was significant in Group D. No significant differences were observed in perioperative blood loss, effusion in the knee joint, thigh swelling or oozing on the wound area among the groups except thigh bruising, which developed more frequently in group D.
CONCLUSION
The reduced dosage and administration period of VTE prophylactic medicine combined with mechanical prophylaxis for Korean TKA patients showed no fatal PE, but some minor bleeding incidents frequently developed with 7 days of dalteparin injections. We need to adjust the dosage and duration of prophylactic medication deliberately for Korean TKA patients, considering prophylaxis effectiveness and bleeding complication risks.

Keyword

arthroplasty, replacement, knee; venous thromboembolism; deep vein thrombosis; pulmonary embolism; bleeding

MeSH Terms

Arthroplasty
Arthroplasty, Replacement, Knee
Aspirin
Dalteparin
Hemorrhage
Humans
Incidence
Knee
Knee Joint
Pulmonary Embolism
Thigh
Venous Thromboembolism
Venous Thrombosis
Aspirin
Dalteparin

Figure

  • Figure 1 A 75-year-old woman, who underwent total knee arthroplasty on her right knee, was diagnosed with deep vein thrombosis in the calf muscular tributary vein (arrow) by computed tomographic angiography.

  • Figure 2 A 74-year-old woman, who underwent total knee arthroplasty on her right knee, was diagnosed with thrombus at the popliteal area (A) and at the pulmonary vessel (B). These figures demonstrate deep vein thrombosis at the popliteal vein (arrow) and pulmonary embolism at right lower lobe basal segmental pulmonary artery (arrowhead) by computed tomographic angiography.


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