Epidemiology of post-operative venous thromboembolismin asian countries

Abstract

In Asia, the prevalence of post-operative venous thromboembolism (VTE) is traditionally thought to be low and the routine use of thromboprophylaxis remains controversial. We performed an exhaustive literature search for published studies on VTE in Asia. Predefined data were extracted from individual studies: country involved, number of patients, type of patient population, type, duration and dose regimens of treatments, if any, method used to detect deep-vein thrombosis (DVT) and pulmonary embolism (PE), and duration of follow-up. The main endpoints were the incidences of systematically detected DVT, and symptomatic DVT or PE. Overall adjusted percentages and 95% confidence intervals (CI) were calculated. In clinical studies in patients not receiving thromboprophylaxis, the adjusted incidence of total DVT was 13% (95% CI: 10% to 16%) in general surgery, 16% (95% CI: 13% to 20%) after total hip replacement, 50% (95% CI: 44% to 55%) after total knee replacement and 18% (95% CI: 12% to 24%) in hip fracture surgery. The adjusted incidence of PE was 1% (95% CI: 0% to 2%) in general surgery and 1.4% (95% CI: 1% to 3%) after total hip replacement. In autopsy studies, the incidence of fatal PE ranged from 0.2% to 6.0%, increasing consistently over a period of 30 years in Japan and Hong Kong. Post-operative VTE is frequent in Asian general and orthopedic surgery patients and the incidence of autopsy-proven fatal PE is increasing over time. The use of routine prophylaxis in Asian patients undergoing high-risk surgical procedures should be considered.