人工関節置換術後における遠位型深部静脈血栓症の検討

抄録

Objective: Venous thromboembolism (VTE) is a complication that should be avoided when performing arthroplasty. We examined the prophylactic and therapeutic effects of anticoagulation on postsurgical onset of distal deep vein thrombosis (DVT).

Methods: The screened subjects included 139 patients who underwent hip and knee arthroplasty. After excluding seven cases of existing proximal DVT, a total of 132 were enrolled in the study. DVT was evaluated by presurgical ultrasonography and ultrasonography at both 3 and 14 days after surgery. Pulmonary embolism (PE) as a complication of DVT, was identified by either contrast-enhanced chest computed tomography or lung perfusion scintigraphy. Anticoagulation after surgery included either fondaparinux, enoxaparin, or edoxaban. A total of 41 patients were treated with fondaparinux (group A), while 35 patients were treated with enoxaparin (group B), and 56 patients were treated with edoxaban (group C). Prophylactic anticoagulant for the 35 patients with asymptomatic distal DVT continued for 14 days (Prevention group), while the 11 cases of symptomatic PE received treatment doses of anticoagulation (Treatment group 11 cases). The incidence of VTE up to postoperative day 14 between groups A, B, and group C was evaluated. We studied thrombus formation, the incidence of thrombus dissolution, and bleeding for up to 14 days after surgery in both the prophylactic and treatment groups.

Results: VTE for up to 14 days after surgery was found in 15 patients in group A (36.5%), 11 patients in group B (31.4%), and 20 patients in group C (35.7%). We found that there was no increase in the incidence of thrombus formation at postoperative day 14 in both the prophylactic and the treatment groups. The thrombosis disappeared by postoperative day 14 in 24 patients in the prophylactic group (68.5%) and in eight patients in the treatment group (72.3%). Bleeding was not observed in the prophylactic group (0%), and three patients had bleeding in the treatment group (27.2%).

Conclusion: Anticoagulation for up to 14 days after arthroplasty suppresses DVT when used prophylactically, and such therapy also reduced subsequent bleeding.