Prevention and treatment of venous thromboembolism in elderly patients after joint replacement / 中华老年医学杂志

ABSTRACT

Objective To explore the relationship between the prothrombotic state and blood coagulation-fibrinolysis system changes with deep venous thrombosis(DVT)in aged patients after total joint arthroplasty,and to propose preventive measures.Methods 400 patients who underwent total hip or knee replacement from January 2003 to June 2011 were classified into suspected DVT(n=200 cases)and non-suspected DVT(n=200 cases)according to Well's clinical scoring system.The patients were divided into 4 subgroups based on the measures to prevent DVTlow molecular weigh heparin group,intermittent pneumatic bag compression group,combined above measures group,control group who refused any preventive measures.Plasma thrombin-antithrombin complex(TAT),plasmin-α2 antiplasmin complex(PAP)were determined preoperatively.Venous Doppler ultrasound was performed before surgery,4 d and 10 d after surgery to detect the presence of DVT.Results Totally 71 cases(17.8％)were diagnosed as DVT and 5 cases(1.3％)as pulmonary thromboembolism(PTE).The incidence of DVT in suspected DVT group(28.5％,57 cases)was lower than in non-suspected DVT group(7.0 ％,14 cases)(x2 =31.66,P＜ 0.01).Among patients with suspected DVT,the DVT prevalence in combined measures group(2.0 ％,1 cases)was decreased than in low molecular weigh heparin group(14.0％,7 cases),intermittent pneumatic bag compression (34.0％,17 cases)and control groups(64.0％,32 cases)(x2=4.89,17.34,18.01,all P＜0.05).In the patients with non-suspected DVT,the DVT prevalence in combined measures group(0.0％)was lower than in control group(24.0 ％,12 cases)(x2 =13.64,P＜0.01).The average preoperative level of TAT[(9.63±3.06)μg/L]in patients with DVT was higher than without DVT[(2.59±0.87)μg/L](t=35.70,P＜0.01),while PAP level in patients with DVT[(38.52± 21.13)μg/L]was reduced than without DVT[69.75±30.26)μg/L](t=8.27,P＜0.01).Conclusions The levels of TAT and PAP before total hip or knee replacement are predictive for lower extremity DVT.The clinical effectiveness of Well's scoring on DVT prevention is dependent on the different TAT and PAP state.