Background Deep vein thrombosis (DVT) of the lower limbs during operations knee and hip arthroplasty in patients with rheumatic diseases are observed in 7-27% cases.
Objectives To evaluate the efficiency of prevention of DVT in patients with rheumatic diseases and osteoarthritis under comparable conditions.
Methods We have analyzed 304 patients operated in for the period 2012-2013. Of these, 188 - with rheumatic diseases, 116 patients - with osteoarthritis. A distinctive feature of the patients with rheumatic diseases was the presence of concomitant drug therapy for the underlying disease. Thus, 176 (94%) of patients with rheumatic diseases received NSAIDs, 168 (89%) of patients received disease-modifying antirheumatic drugs (DMARDs), 81 (43%) of patients received glucocorticosteroids, 45 (24) % of patients received biologic DMARDs. These drugs indirectly affect the hemostatic system, increase the effect of each other and inhibit platelet hemostasis.
In the preoperative period the incidence of DUS-confirmed DVT was in 12 patients (6.4%) with rheumatic diseases, most of which consisted of patients with systemic lupus erythematosus (SLE) and SLE + anti-phospholipid syndrome (APS) - 7 patients (3,7%) and the incidence of DUS-confirmed DVT was in 15 patients (12.9%). It was old thrombosis usually under vessel recanalization. Patients with post-thrombotic venous disease of the lower extremities for 7 days prior to surgery taken nadroparin or fondaparinux sodium, on the 2nd day after surgery patients was transferred to oral anticoagulants. Another patients (292) with rheumatic diseases and osteoarthritis without DVT in anamnesis received oral anticoagulants – a direct thrombin inhibitor - Dabigatran etexilate (174 patients) and rivaroxaban (118 patients). The first intake of dabigatran etexilate (110mg) or rivaroxaban (10mg) was performed on the first day after the surgery. Later the patients were taking 220 mg (2 capsules) of dabigatran etexilate once per day or 10 mg of rivaroxaban once per day for 28-35 days. Doppler ultrasonography (DUS) was routinely performed preoperatively and on postoperative day 3, 7, 14, then 1 time a month for diagnosing a deep venous thrombosis (DVT). Time of observation was 3 months.
Results None of the patients with rheumatic diseases after knee or hip replacement in the early postoperative period deep vein thrombosis of the lower limbs were found. In the control group of patients with osteoarthritis in the early postoperative period identified 8 cases (6.9%) deep vein thrombosis of the lower limbs. The causes of thrombosis were unjustified self- removal of the drug for 15-20 days after surgery (6 cases), and later appointment of the anticoagulant (2 cases). In the perioperative period of clinically significant bleeding was not seen.
Conclusions Application of the above prevention of deep vein thrombosis of the lower limbs has been effective and convenient in the early postoperative period in patients with rheumatic diseases in replacement of hip or knee joints, but requires further study in patients with osteoarthritis.
Disclosure of Interest None declared