Prognosis of venous thromboembolism in orthopaedic surgery or trauma patients and use of thromboprophylaxis
Por:
Guisado, JG, Trujillo-Santos, J, Arcelus, JI, Bertoletti, L, Fernandez-Capitan, C, Valle, R, Hernandez-Hermoso, JA, Calvo-Sotelo, AE, Nieto, JA and Monreal, M
Publicada:
1 nov 2018
Categoría:
Medicine (miscellaneous)
Resumen:
Background: There is scarce evidence about the prognosis of venous thromboembolism in patients undergoing orthopedic surgery and in patients suffering non-surgical trauma.
Methods: We used the RIETE database (Registro Informatizado de pacientes con Enfermedad Trombo Embolica) to compare the prognosis of venous thromboembolism and the use of thromboprophylaxis in patients undergoing different orthopedic procedures and in trauma patients not requiring surgery.
Results: From March 2001 to March 2015, a total of 61,789 patients were enrolled in RIETE database. Of these, 943 (1.52%) developed venous thromboembolism after elective arthroplasty, 445 (0.72%) after hip fracture, 1,045 (1.69%) after non-major orthopedic surgery and 2,136 (3.46%) after non-surgical trauma. Overall, 2,283 patients (50%) initially presented with pulmonary embolism. Within the first 90 days of therapy, 30 patients (0.66%; 95% CI 0.45-0.93) died from pulmonary embolism. The rate of fatal pulmonary embolism was significantly higher after hip fracture surgery (n = 9 [2.02%]) than after elective arthroplasty (n = 5 [0.53%]), non-major orthopedic surgery (n = 5 [0.48%]) or non surgical trauma (n = 11 [0.48%]). Thromboprophylaxis was more commonly used for hip fracture (93%) or elective arthroplasty (94%) than for non-major orthopedic surgery (71%) or non-surgical trauma (32%). Major bleeding was significantly higher after hip fracture surgery (4%) than that observed after elective arthroplasty (1.6%), non-major orthopedic surgery (1.5%) or non-surgical trauma (1.4%).
Conclusions: Thromboprophylaxis was less frequently used in lower risk procedures despite the absolute number of fatal pulmonary embolism after non-major orthopedic surgery or nonsurgical trauma, exceeded that observed after high risk procedures. (C) 2018 Elsevier Espana, S.L.U. and Sociedad Espanola de Medicina Interna (SEMI). All rights reserved.
Filiaciones:
Guisado, JG:
Univ Francisco de Vitoria, Hosp ASEPEYO, Dept Med Interna, Madrid, Spain
Trujillo-Santos, J:
Hosp Gen Univ Santa Lucia, Dept Med Interna, Murcia, Spain
Arcelus, JI:
Hosp Univ Virgen de la Nieves, Dept Cirugia Gen, Granada, Spain
Bertoletti, L:
CHU St Etienne, Hop Nord, Dept Med & Terapeut, St Etienne, France
Fernandez-Capitan, C:
Hosp Univ La Paz, Dept Med Interna, Madrid, Spain
Valle, R:
Hosp Sierrallana, Dept Med Interna, Torrelavega, Cantabria, Spain
Hernandez-Hermoso, JA:
Hosp Badalona Germans Trias & Pujol, Serv Cirugia Ortoped, Barcelona, Spain
Calvo-Sotelo, AE:
Univ Francisco de Vitoria, Hosp ASEPEYO, Dept Med Interna, Madrid, Spain
Nieto, JA:
Hosp Gen Virgen de la Luz, Dept Med Interna, Cuenca, Spain
:
Hosp Badalona Germans Trias & Pujol, Dept Med Interna, Barcelona, Spain
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