Epidemiology of venous thromboembolism in Asian patients undergoing major orthopedic surgery without thromboprophylaxis. The SMART Study
Epidemiology of venous thromboembolism in Asian patients undergoing major orthopedic surgery without thromboprophylaxis. The SMART Study
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DOI：
10.1111/j.1538-7836.2004.01094.x
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发表时间：
2005-01-01
影响因子：
10.4
通讯作者：
Dans, A
中科院分区：
文献类型：
--
作者：
Leizorovicz, A;Turpie, AGG;Dans, A
背景资料：在接受手术的亚洲患者中，静脉血栓栓塞（VTE）的发生率被认为相对于西方患者较低，常规使用血栓预防是有争议的。目的：这项工作的目的是研究亚洲骨科手术患者中静脉血栓栓塞的流行病学。患者和方法：我们对一组连续住院接受全髋关节或膝关节置换术或髋关节骨折手术但未进行血栓预防的亚洲患者进行了前瞻性观察研究。主要研究结局为出院时症状性VTE或猝死复合事件的发生率。在1个月的随访中也评估了这一结果。结果：2001年4月至2002年7月，2420例患者入组。中位年龄为68岁，中位住院时间为13天。研究者报告的症状性VTE或猝死的发生率为2.3% [55例患者，99%置信区间（CI）1.6，3.2]，独立委员会裁定后为1.2%（28例患者，99% CI 0.7，1.8）。慢性心力衰竭、静脉曲张和静脉血栓栓塞病史是主要终点发生的独立危险因素（P < 0.05）。在1个月随访时，裁定的症状性VTE或猝死的发生率为1.5%（35/2264例患者）。结论：在亚洲患者中，大骨科手术后症状性VTE的发生率并不低，与西方国家观察到的发生率一致。在接受此类高风险外科手术的亚洲患者中，应考虑使用血栓预防。
Background: In Asian patients undergoing surgery, the incidence of venous thromboembolism (VTE) is thought to be low relative to Western patients, and the routine use of thromboprophylaxis is controversial. Objectives: The aim of this work was to study the epidemiology of VTE in Asian patients undergoing orthopedic surgery without thromboprophylaxis. Patients and methods: We performed a prospective observational study of a cohort of consecutive Asian patients hospitalized for total hip or knee replacement or hip fracture surgery without thromboprophylaxis. The primary study outcome was the incidence of the composite of symptomatic VTE or sudden death at hospital discharge. This outcome was also assessed at I month's follow-up. Results: Between April 2001 and July 2002, 2420 patients were enrolled. Median age was 68 years and the median duration of hospital stay was 13 days. The rate of symptomatic VTE or sudden death as notified by investigators was 2.3% [55 patients, 99% confidence interval (CI) 1.6, 3.2] and 1.2% (28 patients, 99% CI 0.7, 1.8) after adjudication by an independent committee. Chronic heart failure, varicose veins and a history of VTE were independent risk factors (P < 0.05) for the occurrence of the primary endpoint. At 1 month's follow-up, the incidence of adjudicated symptomatic VTE or sudden death was 1.5% (35/2264 patients). Conclusion: In Asian patients, the incidence of symptomatic VTE after major orthopedic surgery is not low, consistent with the rates observed in Western countries. The use of thromboprophylaxis should be considered in Asian patients undergoing such high-risk surgical procedures.