Pharmacological thromboprophylaxis and its impact on venous thromboembolism following total knee and hip arthroplasty in Korea: A nationwide population-based study

PLoS One. 2017 May 24;12(5):e0178214. doi: 10.1371/journal.pone.0178214. eCollection 2017.

Abstract

Background: Limited data is available regarding the pharmacological prophylaxis for venous thromboembolism (VTE) in Asian patients undergoing total knee arthroplasty or total hip arthroplasty (TKA/THA).

Methods: We performed a population-based epidemiological study using the Health Insurance Review and Assessment Service database to estimate the rate of pharmacological thromboprophylaxis and its impact on VTE in Korean patients who underwent TKA/THA between 2009 and 2013.

Results: We identified 306,912 cases (TKA, 261,260; THA, 45,652). The pharmacological thromboprophylaxis rate was 57.16% (TKA, 58.32%; THA, 50.51%), which increased from 42.81% in 2009 to 65.92% in 2013 (P = 0.0165). Both low-molecular-weight-heparin (22.42%) and rivaroxaban (22.71%) were the most common drugs for prophylaxis. The number of patients aged ≥ 60 years (87.31% vs. 81.01%, P < 0.0001), cases requiring general anesthesia (20.70% vs. 18.37%, P < 0.0001), and cases requiring long hospital stay (median, 13 days vs. 12 days, P < 0.0001) were significantly greater in the pharmacological prophylaxis group. The incidence of VTE within 3 months of surgery was 1.52% (TKA, 1.46%; THA, 1.87%). Patients with pharmacological prophylaxis had higher VTE rates (TKA, 1.69% vs. 1.14%; THA, 2.30% vs. 1.43%) than those without prophylaxis, with advanced age, use of general anesthesia, and a longer hospital stay increasing the risk of VTE. However, rivaroxaban significantly reduced the incidence of VTE following TKA (0.82% vs. 1.14%; odd ratio [OR], 0.72; 95% CI, 0.65-0.79). Moreover, ≥ 10 days of pharmacological thromboprophylaxis was significantly associated with lower incidence of VTE after TKA (1.33% vs. 1.52%; OR, 0.87; 95% CI, 0.81-0.94).

Conclusion: This represents the largest epidemiological study showing a gradual increase in the use of pharmacological prophylaxis in Korean patients undergoing TKA/THA. Although the incidence of VTE is still low without pharmacological prophylaxis, this study demonstrates that the incidence of VTE can be reduced further using appropriate pharmacological thromboprophylaxis strategies.

MeSH terms

  • Aged
  • Anticoagulants / therapeutic use*
  • Arthroplasty, Replacement, Hip / adverse effects*
  • Arthroplasty, Replacement, Knee / adverse effects*
  • Aspirin / therapeutic use
  • Erythrocyte Transfusion
  • Factor Xa Inhibitors / therapeutic use
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Fondaparinux
  • Heparin, Low-Molecular-Weight / therapeutic use
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Polysaccharides / therapeutic use
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control*
  • Postoperative Hemorrhage / epidemiology
  • Postoperative Hemorrhage / etiology
  • Republic of Korea / epidemiology
  • Risk Factors
  • Rivaroxaban / therapeutic use
  • Venous Thromboembolism / epidemiology
  • Venous Thromboembolism / etiology
  • Venous Thromboembolism / prevention & control*

Substances

  • Anticoagulants
  • Factor Xa Inhibitors
  • Fibrinolytic Agents
  • Heparin, Low-Molecular-Weight
  • Polysaccharides
  • Rivaroxaban
  • Fondaparinux
  • Aspirin

Grants and funding

This work was supported by a grant from the Seoul National University Bundang Hospital (13-2015-025). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.