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AB0382 Prevention of Venous Thromboembolism (Vte) after Total Knee Replacement in Patients with Rheumatoid Arthritis
  1. A. Rybnikov1,
  2. E. Byalik1,
  3. T. Reshetnyak2,
  4. S. Makarov1,
  5. M. Makarov1,
  6. V. Pavlov1,
  7. A. Khramov1,
  8. E. Naryshkin1
  1. 1Orthopaedic
  2. 2V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia, Moscow, Russian Federation

Abstract

Background In this study, we analyzed incidences of VTE in patients with rheumatoid arthritis (RA) and osteoarthritis (OA) after total knee or hip arthroplasty, compared schemes of drug prevention and evaluated their efficiency.

Objectives To evaluate the efficiency of prevention of VTE in patients with rheumatoid arthritis and osteoarthritis after total knee replacement under comparable conditions

Methods We studied 151 patients operated in V.A. Nasonova Research Institute of Rheumatology for the period 2014–2015. Of these, 72 patients with RA (47.7%) and 79 patients with OA (52.3%). For a comparative analysis of the efficiency of anticoagulant therapy, each patient group was divided into 2 subgroups by type of drug therapy. The first - nadroparin calcium (the drug therapy was started for 12 hours after the operation at a dose of 0.1 ml per 10 kg of body weight one time per day), the second - nadroparin calcium with transfer to dabigatran etexilate (the first stage of 4 hours after the operation was started therapy by nadroparin calcium, and then after the removal of the epidural catheter moved to the dabigatran etexilate).Doppler ultrasonography (DUS) was routinely performed preoperatively and on postoperative day 7, 14, then 1 time a month for diagnosing a deep venous thrombosis (DVT). Time of observation was 6 months.

Results VTE were reported in 6 (3.9%) patients, 1 of them (0.7%) with RA and 5 (3.3%) with OA. Distal deep vein thrombosis developed on 15 days after total knee replacement in RA patient. He received nadroparin calcium only. 4 patients with VTE after surgery from OA group used nadroparin calcium and 1 patient was on combined drug therapy. Of the 6 cases of VTE 4 (66.7%) were asymptomatic and 2 (33.3%) with development of clinical and laboratory picture. The case of thrombosis in a group of RA was asymptomatic. In a perioperative period of clinically significant bleeding was not seen.

Conclusions Cases of VTE in patients with RA, despite the large number of risk factors, under comparable conditions is significantly lower than patients with OA. The number of asymptomatic deep vein thrombosis prevails over the development of clinical and laboratory complex of symptoms in both groups. In patients with RA and OA who were from the first group have reported 5 cases of VTE and only 1 case of VTE have reported in patients who were from second group. Combined drug VTE prevention in patients with RA and OA has been most effective and safe.

Disclosure of Interest None declared

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