Abstract
Patients with a history of venous thromboembolism (VTE) are considered at very high risk for recurrence after lower limb arthroplasty (LLA). However, the chance of a new VTE episode after LLA has not been yet quantified. The aim of this study was to define the incidence of VTE recurrence following knee and hip arthroplasty.
The case notes for all LLA patients treated at our hospital from 2009 to 2011 were reviewed. There were 5946 primary and revision LLA operations in total; 118 of these interventions were performed in 106 patients with a history of VTE. This group included 69 females and 37 males with a mean age of 69.9. Routine thromboprophylaxis for LLA patients included mechanical (footpumps & TED stockings) plus chemical prophylaxis using Aspirin 150 mg for 6 weeks. Patients with a VTE history had the same mechanical prophylaxis but received warfarin for 3 months.
There were no fatal VTEs within 90 days of surgery. There were 5 episodes (4.2%) of VTE recurrence and specifically 4 PE and one DVT (femoral vein) at 4 months after the operation. Two of the PEs were asymptomatic, diagnosed on CTPA scans being requested for low O2 saturations on routine monitoring. In the group of patients without a VTE history there were 35 VTE episodes (0.6%), indicating a significantly lower rate of VTE (p=0.001) in comparison with the study group.
Patients with a history of VTE had a 4.2% chance of having a further VTE. This is seven times greater than the rate among all other patients despite using more aggressive chemoprophylaxis.
