Similar Clinical Outcomes with Preoperative and Postoperative Start of Thromboprophylaxis in THA: A Register-based Study.
Background: Elective THA is associated with a high risk of thromboembolic events. Although these events may be less common now than they were in the past, they can be serious, and most patients undergoing the procedure therefore still receive thromboprophylaxis. However, controversy remains regardin...
| Publicado en: | Clinical Orthopaedics & Related Research® Vol. 475; no. 9; pp. 2245 - 2253 |
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| Autores principales: | , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Lippincott Williams & Wilkins
Sep2017
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=124430301&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 124430301 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 0009921X 23N jtl: Clinical Orthopaedics & Related Research® issn: 0009921X maglogo: N pubinfo: dt: Sep2017 vid: 475 iid: 9 pid: 433 pub: Lippincott Williams & Wilkins place: Baltimore, Maryland artinfo: ui: 124430301 124430301 NLM28643079 124430301 10.1007/s11999-017-5419-1 NLM28643079 124430301 ppf: 2245 ppct: 8 formats: tig: atl: Similar Clinical Outcomes with Preoperative and Postoperative Start of Thromboprophylaxis in THA: A Register-based Study. aug: au: Borgen, Pål Pripp, Are Dybvik, Eva Leistad, Lilian Dahl, Ola Reikerås, Olav Borgen, Pål O Pripp, Are H Dahl, Ola E Reikerås, Olav affil: Department of Orthopaedics , Martina Hansens Hospital , Dønskiveien 8 1346 Gjettum Norway sug: subj: Postoperative Hemorrhage Prevention and Control Arthroplasty, Replacement, Hip Adverse Effects Postoperative Hemorrhage Epidemiology Heparin, Low-Molecular-Weight Administration and Dosage Thromboembolism Prevention and Control Thromboembolism Epidemiology Anticoagulants Administration and Dosage Postoperative Period Prospective Studies Male Thromboembolism Etiology Arthroplasty, Replacement, Hip Methods Preoperative Period Surgery, Elective Adverse Effects Postoperative Hemorrhage Etiology Middle Age Aged Human Treatment Outcomes Surgery, Elective Methods Norway Incidence Odds Ratio Data Collection Female Logistic Regression Validation Studies Comparative Studies Evaluation Research Multicenter Studies Personal Resource Questionnaire Scales Social Readjustment Rating Scale Middle Aged: 45-64 years Aged: 65+ years Male Female ab: Background: Elective THA is associated with a high risk of thromboembolic events. Although these events may be less common now than they were in the past, they can be serious, and most patients undergoing the procedure therefore still receive thromboprophylaxis. However, controversy remains regarding whether to begin thromboprophylaxis before THA or after to best balance the risks of clotting and bleeding.Questions/purposes: We asked the following questions: (1) Is there a difference in bleeding events with pre- versus postoperative thromboprophylaxis? (2) Is there a difference in thromboembolic episodes after THA between the two regimens? (3) How do the two approaches of thromboprophylaxis influence mortality, readmissions, and other complications?Methods: We used a population-based followup design with predefined data based on international health codification to assess clinical effects of LMWH prophylaxis initiated before or after THA. We took data limited to primary THAs done in Norway between January 1, 2008, and December 31, 2011, from the Norwegian Arthroplasty Register and the National Patient Register to have necessary data elements to complete the study. The two registers were merged after identifying patients with their 11-digit personal identification number (Social Security number). We obtained data regarding demographics, administrative and surgical details, and episode histories for prophylaxis-related events within 180 days of surgery. A total of 25,163 patients undergoing THA were included for analysis, and 9977(40%) versus 15,186 (60%) patients received pre- and postoperative LMWH, respectively. We performed statistical adjustment for differences in baseline characteristics using multivariate logistic regression.Results: After adjustment for age, sex, operation time, year of surgery, and American Society of Anesthesiologists class, we could not show major differences in bleeding events; (odds ratio [OR], 1.04; 95% CI, 0.88-1.22; p = 0.660), thromboembolic episodes; (OR, 1.03; 95% CI, 0.84-1.27; p = 0.786), or other postoperative clinical complications; (OR, 0.86; 95% CI, 0.76-0.99; p = 0.034), with the two regimens. Six-month mortality was similar, (OR, 0.76; 95% CI, 0.56-1.05; p = 0.093), and the readmission rate was higher in the preoperative group; (OR, 0.92; 95% CI, 0.85-0.97; p = 0.016).Conclusions: The risk for postoperative complications seems to be comparable whether LMWH prophylaxis is initiated before or after THA. The postoperative approach reduces costs, decreases risks related to neuraxial anesthesia, and facilitates same-day admissions. Methods for individual risk assessment including laboratory tests would be feasible.Level Of Evidence: Level III, therapeutic study. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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