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THU0179 Incidence of deep vein thrombosis after total hip replacement in patients with rheumatoid arthritis
  1. A Rybnikov,
  2. E Byalik,
  3. S Makarov,
  4. T Reshetnyak,
  5. A Khramov,
  6. E Naryshkin,
  7. D Ivanov,
  8. V Pavlov
  1. Orthopaedic, V.A.Nasonova research institute of rheumatology, Moscow, Russian Federation

Abstract

Background The purpose of this study was to compare incidences of VTE in patients with rheumatoid arthritis (RA) and osteoarthritis (OA) after total hip arthroplasty, different strategies for prevention of VTE and evaluate their efficiency.

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

Methods A one-year prospective cohort study was performed on 173 primary THA patients operated in V.A. Nasonova Research Institute of Rheumatology for the period 2016. Of these, 91 patients with RA (52.6%) and 82 patients with OA (47.4%). 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 DVT were reported in 8 (4.8%) patients, 2 of them (1.2%) with RA and 6 (3.4%) with OA. Distal DVT developed on 8 and 17 days after total hip replacement in RA patient's group. They received nadroparin calcium only. 5 patients with VTE after surgery from OA group used nadroparin calcium and 1 patient was on combined drug therapy. Of the 8 cases of VTE - 6 (75%) were asymptomatic and 2 (25%) with development of clinical and laboratory picture. All cases 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 DVT dominates symptomatic both comparison groups. In patients with RA and OA who were from the first group have reported 6 cases of VTE and only 1 case of VTE have reported in patients who were from second group. Prevention of VTE by combination of LMWH and NOACs was more effective and safety in RA and OA patients.

Disclosure of Interest None declared

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