Title: Incidence of symptomatic Venous Thrombo Embolism (VTE), with or without chemoprophylaxis, in patients undergoing Total Knee Replacement: A comparative study
Authors: Tom Jose, Murukan Babu, Georgy J Kuruvilla
DOI: https://dx.doi.org/10.18535/jmscr/v5i7.146
Abstract
Background: The incidence of Venous Thrombo Embolism (VTE) in Western population undergoing major orthopaedic surgery without any thromboprophylaxis has been reported to range from 32% to 88%. But there is a firm belief that this complication is rare in Asian patients. Majority of publications on thromboembolic disease are from the West and some studies from Asia often contradict this. They say, routine chemoprophylaxis is perhaps not justified in every patient, instead high level of suspicion and close clinical monitoring is only what is required. The issue has acquired greater significance in Indian subjects in recent times as there is an exponential increase in the number of joint replacement surgeries and surgeries for lower limb fractures. Very few studies have been published from India on the subject and very little is known about the true incidence of the condition. In this context this study was designed.
Objectives: To study the incidence of symptomatic VTE in patients with and without chemoprophylaxis
Methods: 110 patients who underwent Total Knee Replacement (26 bilateral and 84 unilateral knees) during a period between October 2011 and October 2013 were studied for the occurrence of symptomatic VTE. All of these,110 patients received chemoprophylaxis. Each of these patients were assessed for 1 month for any clinical signs or symptoms that may show the presence of underlying VTE—such as, fever, calf swelling, pain or tenderness of calf. If there was suspicion of VTE, an ultrasound examination was carried out and VTE was confirmed. The results from this study were compared with 57 patients who underwent surgery during the period 2008 -2011 who received no chemoprophylaxis.
Results: Among the 110 patients who received chemoprophylaxis only one person developed symptomatic VTE (0.9%). There was no significant bleeding or wound healing problems which needed specific procedures or discontinuation of treatment. In the group of 57 which didn’t receive chemoprophylaxis, 5 patients developed symptomatic VTE (8.7%).
Conclusion: The study shows a significant reduction in VTE with chemoprophylaxis and hence routine chemoprophylaxis in every patient undergoing Total Knee Replacement is clearly justified
Keywords-Venous thromboembolism, Chemoprophylaxis, Total Knee Replacement, Deep vein thrombosis.
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Tom Jose
Rajagiri Hospital, Chunagamvely, Aluva, Ernakulam District, Kerala India
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