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The impact of venous thromboembolism (VTE) and bleeding in patients undergoing major joint surgery has not been thoroughly studied. The Spanish National Discharge Database during the years 2005-2006 was used to assess the frequency and clinical impact of VTE and bleeding after elective total knee (TKA) or hip (THA) arthroplasty. Of 58,037 patients undergoing TKA, 0.18% (95% confidence interval [CI]: 0.15-0.22) were diagnosed with pulmonary embolism (PE), 0.57% (95%
0.51-0.63) with deep-vein thrombosis (DVT), 1.20% (95%
1.12-1.30) had bleeding complications, and 0.09% (95%
0.07-0.12) died. Of 54 patients who died, 20.4% (95%
10.7-35.4) had been diagnosed with PE, 3.70% (95%
0.63-11.7) with DVT, and 13.0% (95%
5.67-25.6) had bled. Of 31,769 patients undergoing elective THA, 0.23% (95%
0.18-0.29) were diagnosed with PE, 0.44% (95%
0.37-0.52) with DVT, 1.21% (95%
1.10-1.34) bled, and 0.16% (95%
0.12-0.21) died. Of 52 patients who died, 13.5% (95%
6.08-24.8) had been diagnosed with PE, and 9.61% (95%
3.52-21.3) had bled. On multivariable analysis, PE (odds ratio [OR]: 157; 95%
75-328), DVT (
1.5-27) and bleeding (
3.6-20) were independent predictors for death after TKA. After THA, only PE (
26-160) and bleeding (
2.3-17) predicted the risk for death. Bleeding, DVT, and PE, arising after TKA were all independent predictors for death. Their increase in risk was, however, substantially higher for PE. After THA, only PE and bleeding independently predicted death.
Prof. Manuel Monreal, MD, PhD, Servicio de Medicina Interna, Hospital Universitario Germans Trias i Pujol, 08916 Badalona (Barcelona), Spain, E-mail: firstname.lastname@example.org.
This article was published in the following journal.
Name: Thrombosis and haemostasis
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Replacement of the knee joint.
Impaired venous blood flow or venous return (venous stasis), usually caused by inadequate venous valves. Venous insufficiency often occurs in the legs, and is associated with EDEMA and sometimes with VENOUS STASIS ULCERS at the ankle.
Agents acting to arrest the flow of blood. Absorbable hemostatics arrest bleeding either by the formation of an artificial clot or by providing a mechanical matrix that facilitates clotting when applied directly to the bleeding surface. These agents function more at the capillary level and are not effective at stemming arterial or venous bleeding under any significant intravascular pressure.
Obstruction of a vein or VEINS (embolism) by a blood clot (THROMBUS) in the blood stream.
A vascular anomaly characterized by a radial or wedge-shaped arrangement of dilated VEINS draining into a larger vein in the brain, spinal cord, or the meninges. Veins in a venous angioma are surrounded by normal nervous tissue, unlike a CENTRAL NERVOUS SYSTEM CAVERNOUS HEMANGIOMA that lacks intervening nervous tissue. Drainage of venous angioma is fully integrated with the body's venous system, therefore, in most cases there is no clinical signs and rare bleeding.
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