Venous thromboembolism in 13 Indonesian patients undergoing major orthopedic surgery
Abstract
Aim To estimate the incidence of VTE in Indonesian patients undergoing major orthopedic surgery and not receiving thromboprophylaxis.
Methods This was an open clinical study of consecutive Indonesian patients undergoing major orthopedic surgery, conducted in 3 centers in Jakarta. Bilateral venography was performed between days 5 and 8 after surgery to detect the asymptomatic and to confirm the symptomatic VTE. These patients were followed up to one month after surgery.
Results A total of 17 eligible patients were studied, which a median age of 69 years and 76.5% were females. Sixteen out of the 17 patients (94.1%) underwent hip fracture surgery (HFS). The median time from injury to surgery was 23 days (range 2 to 197 days), the median duration of surgery was 90 minutes (range 60 to 255 minutes), and the median duration of immobilization was 3 days (range 1 to 44 days). Thirteen out of the 17 patients were willing to undergo contrast venography. A symptomatic VTE was found in 9 patients (69.2%) at hospital discharge. Symptomatic VTE was found in 3 patients (23.1%), all corresponding to clinical signs of DVT and none with clinical sign of PE. These patients were treated initially with a low molecular weight heparin, followed by warfarin. Sudden death did not occur up to hospital discharge. From hospital discharge until 1-month follow-up, there were no additional cases of symptomatic VTE. No sudden death, bleeding complication, nor re-hospitalization was found in the present study.
Conclusion The incidence of asymptomatic (69.2%) and symptomatic (23.1%) VTE after major orthopedic surgery without thromboprophylaxis in Indonesian patients (SMART and AIDA), and still higher than the results of the Western studies. A larger study is required to establish the true incidence, and more importantly, that the use of thromboprophylaxis in these patients is warranted. (Med J Indones 2009; 18: 249-56)
References
Leizorovicz A, Turpie AGG, Cohen AT, Dhillon KS, Angchaisuksiri P, Wang C-J, for the SMART Study Group. Epidemiology of post-operative venous thromboembolism in Asian Countries. Int J Angiol. 2004; 13 : 101-8.
Dhillon KS, Askander A, Doraisamy S. Postoperative deep-vein thrombosis in Asian patients is not a rarity: a prospective study of 88 patients with no prophylaxis. J Bone Joint Surg. 1996; 78-B (3): 427-30.
Leizorovicz A, Turpie AGG, Cohen AT, Wong L, Yoo MC, Dans A, for the SMART Study Group. Epidemiology of venous thromboembolism in Asian patients undergoing major orthopedic surgery without thromboprophylaxis. The SMART Study. J Thromb Haemost. 2005; 3 : 28 – 34.
Leizorovicz A on behalf of the SMART Venography Study Steering Committee. Epidemiology of post-operative venous thromboembolism in Asian patients. Results of the SMART venography study. Hematologica. 2007; 92: 1194 – 200.
Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, et al. Prevention of venous thromboembolism: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2004;126 : 338 – 400.
Nicolaides AN, Fareed J, Kakkar AK, Breddin HK, Goldhaber SZ, Hull R, et al. Prevention and treatment of venous thromboembolism. International Concensus Statement. Guidelines according to scientifi c evidence. Int Angiol. 2006; 25(2) : 101 – 61.
White RH. The epidemiology of venous thromboembolism. Circulation. 2003; 107 : I-4 – I-8
American Thoracic Society : Medical Section of the American Lung Association. The diagnostic approach to acute venous thromboembolism. Clinical Practice Guideline. Am J Respir Crit Care Med. 1999; 160 : 1043 – 66.
Piovella F, Wang C-J, Lu H, Lee K, Lee LH, Lee WC, et al, for the AIDA Investigators. Deep-vein thrombosis rates after major orthopedic surgery in Asia. An epidemiological study based on postoperative screening with centrally adjudicated bilateral venography. J Thromb Haemost. 2005; 3 : 2664 – 70.
Kakkar VV, Howe CT, Flanc C, Clarke MB. Natural history of postoperative deep-vein thrombosis. Lancet. 1969; 2 : 230 – 2.
Copyright (c) 2009 Karmel L. Tambunan, Errol U. Hutagalung, Lugyanti Sukrisman, Ifran Saleh, S. B. Gunawan, Sofyanuddin Sofyanuddin, Arini Setiawati
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.
