Low risk of thromboembolic complications after fast-track hip and knee arthroplasty.
Low risk of thromboembolic complications after fast-track hip and knee arthroplasty.
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DOI：
10.3109/17453674.2010.525196
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发表时间：
2010-10
影响因子：
3.7
通讯作者：
Kehlet H
中科院分区：
文献类型：
--
作者：
Husted H;Otte KS;Kristensen BB;Ørsnes T;Wong C;Kehlet H
药物预防可以降低深静脉血栓形成（DVT）、肺栓塞（PE）和死亡的风险，建议在全髋关节置换术（THA）后10-35天和全膝关节置换术（TKA）后至少10天使用。然而，早期活动也可能降低DVT的风险，从而减少长期预防的需要，但在以前的文献中没有考虑到这一点。在这里，我们报告我们的结果与短期药物预防结合早期动员和减少住院。2004-2008年，在一个描述良好的标准化快速通道设置中，1，977例连续的髋关节置换患者接受了初次THA、TKA或双侧同时TKA（BSTKA）手术。患者在术后6-8小时开始接受低分子量肝素预防DVT，直至出院。使用国家健康登记册分析30和90天内的所有再入院和死亡，特别关注临床DVT（经超声和D-二聚体升高证实），PE或猝死。数量与预防天数（LOS）相关。平均住院天数从2004年的7.3天减少到2008年的3.1天。3例死亡（0.15%）与凝血发作相关，共发现11例临床DVT（0.56%）和6例PE（0.30%）。绝大多数事件发生在30天内;仅1例死亡和2例DVT发生在30 - 90天之间。在过去的2年中（854例患者），当患者在术后4小时内活动并且DVT预防持续时间最短（1-4天）时，死亡率为0%（95%CI：0-0.5）。全膝关节置换术中DVT的发生率为0.60%（CI：0.2-2.2），全髋关节置换术中为0.51%（CI：0.1-1.8），BSTKA中为0%（CI：0-2.9）。TKA的PE发生率为0.30%（CI：0.1-1.7），THA为0%（CI：0-1.0），BSTKA为0%（CI：0-2.9）。与已发表的延长预防（最长36天）和住院最长11天的方案相比，采用早期活动、住院时间短和DVT预防持续时间短的快速通道设置后，THA和TKA后发生临床DVT以及致死性和非致死性PE的风险更高。这需要重新考虑化学血栓预防的最佳持续时间。
Pharmacological prophylaxis can reduce the risk of deep venous thrombosis (DVT), pulmonary embolism (PE), and death, and it is recommended 10–35 days after total hip arthroplasty (THA) and at least 10 days after total knee arthroplasty (TKA). However, early mobilization might also reduce the risk of DVT and thereby the need for prolonged prophylaxis, but this has not been considered in the previous literature. Here we report our results with short-duration pharmacological prophylaxis combined with early mobilization and reduced hospitalization. 1,977 consecutive, unselected patients were operated with primary THA, TKA, or bilateral simultaneous TKA (BSTKA) in a well-described standardized fast-track set-up from 2004–2008. Patients received DVT prophylaxis with low-molecular-weight heparin starting 6–8 h after surgery until discharge. All re-admissions and deaths within 30 and 90 days were analyzed using the national health register, concentrating especially on clinical DVT (confirmed by ultrasound and elevated D-dimer), PE, or sudden death. Numbers were correlated to days of prophylaxis (LOS). The mean LOS decreased from 7.3 days in 2004 to 3.1 days in 2008. 3 deaths (0.15%) were associated with clotting episodes and overall, 11 clinical DVTs (0.56%) and 6 PEs (0.30%) were found. The vast majority of events took place within 30 days; only 1 death and 2 DVTs occurred between 30 and 90 days. During the last 2 years (854 patients), when patients were mobilized within 4 h postoperatively and the duration of DVT prophylaxis was shortest (1–4 days), the mortality was 0% (95% CI: 0–0.5). Incident cases of DVT in TKA was 0.60% (CI: 0.2–2.2), in THA it was 0.51% (CI: 0.1–1.8), and in BSTKA it was 0% (CI: 0–2.9). Incident cases of PE in TKA was 0.30% (CI: 0.1–1.7), in THA it was 0% (CI: 0–1.0), and in BSTKA it was 0% (CI: 0–2.9). The risk of clinical DVT, and of fatal and non-fatal PE after THA and TKA following a fast-track set-up with early mobilization, short hospitalization, and short duration of DVT prophylaxis compares favorably with published regimens with extended prophylaxis (up to 36 days) and hospitalization up to 11 days. This calls for a reconsideration of optimal duration of chemical thromboprophylaxis.
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影响因子：
8.9
作者：
Heit, JA;Melton, LJ;O'Fallon, WM
通讯作者：
O'Fallon, WM
DOI：
10.1302/0301-620x.84b4.12330
发表时间：
2002-05-01
影响因子：
--
作者：
Kim, YH;Kim, JS
通讯作者：
Kim, JS
DOI：
10.1302/0301-620x.78b3.0780434
发表时间：
1996-05-01
影响因子：
--
作者：
Benoni, G;Fredin, H
通讯作者：
Fredin, H
DOI：
10.1080/00016470308540844
发表时间：
2003-06-01
期刊：
ACTA ORTHOPAEDICA SCANDINAVICA
影响因子：
--
作者：
Dahl, OE;Gudmundsen, TE;Solheim, DM
通讯作者：
Solheim, DM
影响因子：
158.5
作者：
Eriksson, Bengt I.;Borris, Lars C.;Geerts, William
通讯作者：
Geerts, William