Risk of clinical pulmonary embolism after joint surgery in patients receiving low-molecular-weight heparin prophylaxis in hospital -: A 10-year prospective register of 3,954 patients
Risk of clinical pulmonary embolism after joint surgery in patients receiving low-molecular-weight heparin prophylaxis in hospital -: A 10-year prospective register of 3,954 patients
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DOI：
10.1080/00016470308540844
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发表时间：
2003-06-01
期刊：
影响因子：
--
通讯作者：
Solheim, DM
中科院分区：
文献类型：
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作者：
Dahl, OE;Gudmundsen, TE;Solheim, DM
我们研究了在10年的观察期内，大关节手术后经放射学证实的非致命性临床肺栓塞（PE）的发生率。研究结果基于1989年至1998年在斯堪的纳维亚医院接受全髋关节置换术（THR）、全膝关节置换术（TKR）或髓内钉固定髋关节骨折（NHF）的所有患者的前瞻性登记。所有患者均接受低分子肝素预防血栓形成，持续至出院。疑似PE的患者接受了通气/灌注动脉造影和/或螺旋CT。伴有深静脉血栓形成（DVT）临床体征的患者也接受了影像学诊断。3，954例患者接受了THR、TKR或NHF;其中122例因临床怀疑PE而再次入院，50例得到证实。在确诊PE的患者中，6/50例发生DVT。THR后平均再入院时间为35（5-94）天，NHF后平均再入院时间为24（1-173）天，TKR后平均再入院时间为9（2-17）天。大髋关节手术后，在接受血栓预防约10天的患者中，PE的发生率至少在2-3个月内保持较高水平（TKR后较低）。NHF与THR和TKR患者PE发生率和发生时间的差异表明，在确定最佳血栓预防方案时，应单独考虑这些患者。
We studied the incidence of nonfatal, radiologically-confirmed, clinical pulmonary embolism (PE) after major joint surgery during 10 years of observation. The findings are based on a prospective register of all patients undergoing total hip replacement (THR), total knee replacement (TKR), or nailed hip fracture (NHF) in a Scandinavian hospital between 1989 and 1998. All patients received thromboprophylaxis with low-molecular-weight heparin, continued until discharge. Patients with suspected PE underwent ventilation/perfusion scintigraphy and/or spiral CT. Patients with concomitant clinical signs of deep vein thrombosis (DVT) were also subjected to imaging diagnostics. 3,954 patients underwent THR, TKR, or NHF; 122 of them were readmitted on clinical suspicion of PE, and 50 cases were confirmed. Of patients with confirmed PE, 6/50 had DVT. The average time to readmission was 35 (5-94) days after THR, 24 (1-173) days after NHF, and 9 (2-17) days after TKR. Following major hip surgery, the incidence of PE remained high for at least 2-3 months (less following TKR) in those given thromboprophylaxis for about 10 days. The differences in PE incidence and the time when it developed in NHF versus THR and TKR patients suggest that these patients should be considered separately when determining the optimal thromboprophylactic regimen.