Incidence and outcome of postoperative venous thromboembolism in elderly patients underwent knee or hip arthroplasty with multimodal thromboprophylaxis

Abstract

Objective To analyze the incidence and outcome of postoperative venous thromboembolism in elderly patients underwent knee or hip arthroplasty with multimodal prophylaxis. Methods 375 patients were enrolled retrospectively from January, 2015 to July, 2017. All the patients were older than 60 years and underwent unilateral primary knee or hip arthroplasty. A multimodal thromboprophylaxis program were employed, including low molecular heparin and Rivaroxaban for chemoprophylaxis, ankle pump, walking in early phase and pneumatic compression for physical prophylaxis. Color Doppler ultrasonography was used for screening the deep venous thrombosis (DVT) and CT pulmonary artery angiography was utilized for screening pulmonary embolism (PE). The follow-up was carried out for 8 weeks. Results 349 patients had been fully followed up, the following rate was 92.5%. The overall VTE incidence was 10.9% (38/349), with no PE case and 38 distal DVT cases. There were 35 ipsilateral DVT cases and 3 bilateral cases. The incidence of symptomatic DVT was 71.1% (27/38) and asymptomatic was 29.0% (11/38). There were 29 cases with simple gastrocnemius venous thrombosis, 3 cases with calf vein thrombosis in one leg, and 6 cases with combined vein thrombosis. The DVT incidences in patients underwent different surgeries were significantly different (χ2=0.000, P<0.001). TKA group's DVT incidence is 16.3% much higher than UKA group. No medicine was held on those simple gastrocnemius venous thrombosis cases. The other DVT patients were prescribed Rivaroxaban for 4 weeks. All DVT patients were symptom-free and with no post-thrombotic syndrome or progressive DVT and PE. Conclusions With multimodal thromboprophylaxis, the overall VTE incidence in elderly underwent knee or hip arthroplasty is low and the presented ones were distal VTE. After short-term prognosis or short-term, symptoms disappeared with no sequela. Key words: Arthroplasty, replacement, hip; Arthroplasty, replacement, knee; Aged; Venous thrombosis; Multimodal thromboprophylaxis