Assessment of thrombotic risk factors predisposing to thromboembolic complications in prosthetic orthopedic surgery

G. Szűcs, E. Ajzner, L. Muszbek, Tünde Simon, Kálmán Szepesi, B. Fülesdi

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Congenital thrombophilia is responsible for thromboembolic complications despite prolonged low-molecular-weight heparin (LMWH) prophylaxis following hip and knee endoprosthesis surgery. Methods: A series of 86 patients with hip or knee endoprosthesis surgery were assessed 1 year after operation. Antithrombin III, protein C, and protein S were determined, and the activated protein C sensitivity ratio was measured. We screened for the presence of lupus anticoagulant, factor V Leiden mutation, and polymorphism of prothrombin G20210A. The lower limb venous circulation was monitored by color Doppler ultrasonography. Pulmonary embolism (PE) was diagnosed using ventilation and perfusion scintigraphy. Results: In all, 33 patients had thromboembolic complications, 18 with thrombophilia (7 with combined form). Of the 53 patients without complications 12 had thrombophilia (2 with combined form). The differences were statistically significant. The risk score, the prevalence of FV Leiden and prothrombin G20210A mutations, and lupus anticoagulant were also significantly higher in the symptomatic group. Deep vein thrombosis (DVT) developed preoperatively in 15 patients; DVT and PE in 4 patients; thrombophilia was diagnosed in 53% and 75% of these cases. In all, 17 patients had postoperative thromboembolic complications: DVT developed in nine and PE in one patient (all with thrombophilia); DVT + PE developed in seven patients (all but one had thrombophilia). Conclusions: Significant differences were found in the incidence (P ≤ 0.01) of thrombophilia and the risk score (P ≤ 0.02) between symptomatic and asymptomatic patients. We recommend preoperative thrombophilia screening for patients with a history or familial prevalence of thromboembolism and/or with a high risk score (≥15). In cases of thrombophilia, the form and duration of anticoagulant treatment must be decided individually.

Original languageEnglish
Pages (from-to)484-490
Number of pages7
JournalJournal of Orthopaedic Science
Volume14
Issue number5
DOIs
Publication statusPublished - Sep 2009

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Thrombophilia
Orthopedics
Pulmonary Embolism
Venous Thrombosis
Lupus Coagulation Inhibitor
Prothrombin
Protein C
Hip
Knee
Antithrombin Proteins
Doppler Color Ultrasonography
Mutation
Perfusion Imaging
Antithrombin III
Low Molecular Weight Heparin
Protein S
Thromboembolism
Anticoagulants
Ventilation
Lower Extremity

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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Assessment of thrombotic risk factors predisposing to thromboembolic complications in prosthetic orthopedic surgery. / Szűcs, G.; Ajzner, E.; Muszbek, L.; Simon, Tünde; Szepesi, Kálmán; Fülesdi, B.

In: Journal of Orthopaedic Science, Vol. 14, No. 5, 09.2009, p. 484-490.

Research output: Contribution to journalArticle

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AB - Background: Congenital thrombophilia is responsible for thromboembolic complications despite prolonged low-molecular-weight heparin (LMWH) prophylaxis following hip and knee endoprosthesis surgery. Methods: A series of 86 patients with hip or knee endoprosthesis surgery were assessed 1 year after operation. Antithrombin III, protein C, and protein S were determined, and the activated protein C sensitivity ratio was measured. We screened for the presence of lupus anticoagulant, factor V Leiden mutation, and polymorphism of prothrombin G20210A. The lower limb venous circulation was monitored by color Doppler ultrasonography. Pulmonary embolism (PE) was diagnosed using ventilation and perfusion scintigraphy. Results: In all, 33 patients had thromboembolic complications, 18 with thrombophilia (7 with combined form). Of the 53 patients without complications 12 had thrombophilia (2 with combined form). The differences were statistically significant. The risk score, the prevalence of FV Leiden and prothrombin G20210A mutations, and lupus anticoagulant were also significantly higher in the symptomatic group. Deep vein thrombosis (DVT) developed preoperatively in 15 patients; DVT and PE in 4 patients; thrombophilia was diagnosed in 53% and 75% of these cases. In all, 17 patients had postoperative thromboembolic complications: DVT developed in nine and PE in one patient (all with thrombophilia); DVT + PE developed in seven patients (all but one had thrombophilia). Conclusions: Significant differences were found in the incidence (P ≤ 0.01) of thrombophilia and the risk score (P ≤ 0.02) between symptomatic and asymptomatic patients. We recommend preoperative thrombophilia screening for patients with a history or familial prevalence of thromboembolism and/or with a high risk score (≥15). In cases of thrombophilia, the form and duration of anticoagulant treatment must be decided individually.

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