VTE prevention and management of orthopedic patients
骨科患者的VTE预防和管理

摘要

目的 骨科大手术后，静脉血栓栓塞是一种严重的但可减少并发症的方法。本研究的要点是提供最佳的预防措施，以减少术后静脉血栓栓塞。方法 比较315例深静脉血栓形成的患者接受过大骨外科手术的618人，在前瞻性注册表中进行了普外科连续超声确诊的深静脉血栓形成患者。骨科患者的留置较少中央静脉导管（14.0％ v.s.46.4％，P0.001）以及充血性心力衰竭的发生率更低（7.0％v.s.13.4％，P0.001），癌症（5.1％v.s.28.6％，P0.001）和糖尿病（7.0％v.s.12.6％，P0.004）。肢体不适（43.5％v.s.30.3％，P <.0001）和红斑（10.1％v.s.4.8％，P0.001）更为常见在骨科患者中，但呼吸困难较少见（11.4％v.s.18.0％，P0.005）。使用渐变压力袜（19.4％对比15.0％，P0.04），低分子量肝素（18.7％vs. 12.1％，P0.003）和华法林（31.7％vs。11.0％，P0.001）用于预防深静脉血栓形成在整形外科组。骨外科患者的小腿深静脉频率较高血栓形成比接受一般治疗的患者手术（38.4％vs. 2.1％,P0.001）。在两组中28％的人没有接受预防。总之，尽管合并症较少的骨科患者伴有深静脉血栓形成的小腿深静脉血栓形成仍然特别脆弱。静脉率血栓栓塞的预防不足。结果 对于接受大形骨外科手术的患者，建议使用以下方法之一，而不是不进行抗血栓预防：或间歇性气动压缩装置（IPCD）（1C级）至少持续10到14天。对于需要下肢固定的孤立性下肢损伤患者，建议不进行血栓预防（2B级）建议在出院前不要进行多普勒（或双工）超声检查（1B级）。对于需要下肢固定的孤立性下肢损伤患者，建议不进行血栓预防（2B级）。对于没有VTE病史的膝关节镜检查患者，建议不进行血栓预防（2B级）。对于药物和机械性血栓预防禁忌症的患者（2C级），建议不要使用下腔静脉滤器放置来进行一级预防。建议在出院前不要进行多普勒（或双工）超声检查（1B级）。结论 对于需要下肢固定的孤立性下肢损伤患者，建议不进行血栓预防（2B级）。骨科大手术后预防血栓的最佳策略包括药理学和机械学方法，本研究建议使用药理学方法进行预防。

Abstract

Objective: After major orthopedic surgery, venous thromboembolism is a serious method that can reduce complications. The main point of this study is to provide the best preventive measures to reduce postoperative venous thromboembolism.
Methods: A comparison of 315 patients with deep vein thrombosis who underwent major bone surgery and 618 patients with deep vein thrombosis diagnosed by continuous general surgery in the prospective registry. Orthopedic patients have fewer indwelling central venous catheters (14.0% vs 46.4%, P0.001) and the incidence of congestive heart failure is lower (7.0% vs 13.4%, P0.001), cancer (5.1% vs 28.6%, P0.001) and diabetes (7.0%vs12.6%, P0.004). Limb discomfort (43.5%vs30.3%, P<.0001) and erythema (10.1%vs4.8%, P0.001) are more common in orthopedic patients, but dyspnea is less common (11.4%vs18.0%, P0. 005). Use gradient compression stockings (19.4% vs. 15.0%, P0.04), low molecular weight heparin (18.7% vs. 12.1%, P0.003) and warfarin (31.7% vs. 11.0%, P0.001) for prevention Deep vein thrombosis was in the plastic surgery group. Orthopedic surgery patients had a higher frequency of thrombosis in the deep veins of the calf than patients receiving general treatment (38.4% vs. 2.1%, P0.001). 28% of people in both groups did not receive prevention. In short, although orthopedic patients with fewer comorbidities are accompanied by deep vein thrombosis, deep vein thrombosis of the calf is still particularly vulnerable. Inadequate prevention of venous rate thromboembolism.
Results: For patients undergoing major orthopedic surgery, it is recommended to use one of the following methods instead of no antithrombotic prevention: or intermittent pneumatic compression device (IPCD) (level 1C) for at least 10 to 14 days. For patients with isolated lower extremity injuries who require lower extremity fixation, it is recommended not to prevent thrombosis (level 2B). It is recommended not to perform Doppler (or duplex) ultrasound examination (level 1B) before discharge from the hospital. For patients with isolated lower extremity injuries who require lower extremity fixation, thromboprophylaxis is not recommended (Grade 2B). For knee arthroscopy patients without a history of VTE, thromboprophylaxis is not recommended (Grade 2B). For patients with contraindications to drug and mechanical thrombosis prevention (Grade 2C), it is recommended not to use inferior vena cava filter placement for primary prevention. It is recommended not to perform Doppler (or duplex) ultrasound examination (level 1B) before leaving the hospital.
Conclusion  : For patients with isolated lower extremity injury who require lower extremity fixation, thromboprophylaxis is not recommended (Grade 2B). The best strategies for preventing thrombosis after major orthopedic surgery include pharmacological and mechanical methods. This study recommends the use of pharmacological methods for prevention.