Venous thromboembolism and bleeding after total knee and hip arthroplasty

Ricardo Guijarro; Julio Montes; Carlos San Roman; Juan Ignacio Arcelus; Giovanni Barillari; Xavier Granero; Manuel Monreal

doi:10.1160/TH10-10-0645

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2011; 105(04): 610-615
DOI: 10.1160/TH10-10-0645

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Venous thromboembolism and bleeding after total knee and hip arthroplasty

Findings from the Spanish National Discharge Database

Ricardo Guijarro

¹Department of Internal Medicine, Hospital Carlos Haya, Málaga, Spain

,

Julio Montes

²Department of Internal Medicine, Hospital Meixoeiro, Vigo, Spain

,

Carlos San Roman

¹Department of Internal Medicine, Hospital Carlos Haya, Málaga, Spain

,

Juan Ignacio Arcelus

⁴Department of Surgery, Universidad de Granada and Hospital Virgen de las Nieves, Granada, Spain

,

Giovanni Barillari

⁵Department of Internal Medicine, Center for Hemorrhagic and Thrombotic Disorders, University Hospital of Udine, Italy

,

Xavier Granero

⁶Department of Orthopaedic Surgery, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

,

Manuel Monreal

⁷Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

› Author Affiliations

Abstract

Summary

The impact of venous thromboembolism (VTE) and bleeding in patients undergoing major joint surgery has not been thoroughly studied. The Spanish National Discharge Database during the years 2005–2006 was used to assess the frequency and clinical impact of VTE and bleeding after elective total knee (TKA) or hip (THA) arthroplasty. Of 58,037 patients undergoing TKA, 0.18% (95% confidence interval [CI]: 0.15–0.22) were diagnosed with pulmonary embolism (PE), 0.57% (95% CI: 0.51–0.63) with deep-vein thrombosis (DVT), 1.20% (95% CI: 1.12–1.30) had bleeding complications, and 0.09% (95% CI: 0.07–0.12) died. Of 54 patients who died, 20.4% (95% CI: 10.7–35.4) had been diagnosed with PE, 3.70% (95% CI: 0.63–11.7) with DVT, and 13.0% (95% CI: 5.67–25.6) had bled. Of 31,769 patients undergoing elective THA, 0.23% (95% CI: 0.18–0.29) were diagnosed with PE, 0.44% (95% CI: 0.37–0.52) with DVT, 1.21% (95% CI: 1.10–1.34) bled, and 0.16% (95% CI: 0.12–0.21) died. Of 52 patients who died, 13.5% (95% CI: 6.08–24.8) had been diagnosed with PE, and 9.61% (95% CI: 3.52–21.3) had bled. On multivariable analysis, PE (odds ratio [OR]: 157; 95% CI: 75–328), DVT (OR: 6.3; 95% CI: 1.5–27) and bleeding (OR: 8.5; 95% CI: 3.6–20) were independent predictors for death after TKA. After THA, only PE (OR: 65; 95% CI: 26–160) and bleeding (OR: 6.4; 95% CI: 2.3–17) predicted the risk for death. Bleeding, DVT, and PE, arising after TKA were all independent predictors for death. Their increase in risk was, however, substantially higher for PE. After THA, only PE and bleeding independently predicted death.

Keywords

Prophylaxis - surgery - orthopaedics - venous thrombosis - pulmonary embolism

Full Text

References

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