title: Risk of venous thromboembolism after total knee arthroplasty in patients with rheumatoid arthritis.
abstract: OBJECTIVE
  To compare the incidence of venous thromboembolism (VTE) following total knee arthroplasty (TKA) between patients with rheumatoid arthritis (RA) and those with osteoarthritis (OA).
  
  
  METHODS
  The subjects were composed of 1084 Japanese patients with OA and 204 with RA. Primary effectiveness outcomes were any deep vein thrombosis (DVT) as detected by bilateral ultrasonography up to postoperative Day 10 (POD10) and pulmonary embolism (PE) up to POD28. The main safety outcomes were bleeding and death from any cause up to POD28. Plasma D-dimer levels were measured before and at POD10 after TKA.
  
  
  RESULTS
  The study cohort was composed of 1288 patients from 34 hospitals. There was no death up to POD28. PE occurred in 2 patients with OA and in no patients with RA. The incidence of primary effectiveness outcome was 24.3% and 24.0% in patients with OA and RA, respectively. The incidence of major bleeding up to POD28 was 1.3% and 0.5% in patients with OA and RA, respectively. No differences in the incidence of VTE (symptomatic/asymptomatic DVT plus PE) or bleeding were noted between patients with RA and OA. D-dimer levels on POD10 were significantly higher in patients with OA compared with those with RA. Also, D-dimer levels on POD10 were significantly lower in patients receiving fondaparinux than in patients without pharmacological prophylaxis.
  
  
  CONCLUSIONS
  Despite some differences in demographic data, patients with RA and OA have equivalent risks of VTE and bleeding following TKA.
authors: Japanese NHO-EBM study group and J-PSVT, Nagasaki University Graduate School of Biomedical Sciences.
authors: Masahiro
authors: M
authors: Izumi
authors: From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT. migita@nagasaki-mc.com.
authors: Kiyoshi
authors: K
authors: Migita
authors: From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT.
authors: Mashio
authors: M
authors: Nakamura
authors: From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT.
authors: Yuka
authors: Y
authors: Jiuchi
authors: From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT.
authors: Tatsuya
authors: T
authors: Sakai
authors: From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT.
authors: Takayuki
authors: T
authors: Yamaguchi
authors: From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT.
authors: Tomihiko
authors: T
authors: Asahara
authors: From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT.
authors: Yuichiro
authors: Y
authors: Nishino
authors: From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT.
authors: Seiji
authors: S
authors: Bito
authors: From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT.
authors: Shigeki
authors: S
authors: Miyata
authors: From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT.
authors: Kenji
authors: K
authors: Kumagai
authors: From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT.
authors: Makoto
authors: M
authors: Osaki
authors: From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT.
authors: Masaaki
authors: M
authors: Mawatari
authors: From the Japanese National Hospital Organization (NHO)-Evidence-based Medicine (EBM) study group, and the Japanese study Prevention and Actual situation of Venous Thromboembolism after Total Arthroplasty (J-PSVT), and the Division of Clinical Epidemiology, NHO Tokyo Medical Center, Tokyo; Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, Tsu; Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center, Osaka; Department of Orthopedic Surgery, Nagasaki University Hospital, Nagasaki; Department of Orthopedic Surgery, Saga University Hospital, Saga, Japan.M. Izumi, MD; K. Migita, MD, Japanese NHO-EBM study group and J-PSVT; M. Nakamura, MD, Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine; Y. Jiuchi, PhD; T. Sakai, MD; T. Yamaguchi, MD; T. Asahara, MD; Y. Nishino, MD, Japanese NHO-EBM study group and J-PSVT; S. Bito, MD, Division of Clinical Epidemiology, NHO Tokyo Medical Center; S. Miyata, MD, Division of Transfusion of Medicine, National Cerebral and Cardiovascular Center; K. Kumagai, MD, Japanese NHO-EBM study group and J-PSVT; M. Osaki, MD, Department of Orthopedic Surgery, Nagasaki University Hospital; M. Mawatari, MD, Department of Orthopedic Surgery, Saga University Hospital; S. Motokawa, MD, Japanese NHO-EBM study group and J-PSVT.
authors: Satoru
authors: S
authors: Motokawa
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005343:Fibrinolytic Agents; D006801:Humans; D015994:Incidence; D007564:Japan; D007719:Knee Joint / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020370:Osteoarthritis, Knee / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D017678:Sex Distribution; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*
chemical_list: D005343:Fibrinolytic Agents
keywords: DEEP VEIN THROMBOSIS; OSTEOARTHRITIS; RHEUMATOID ARTHRITIS; THROMBOPROPHYLAXIS; TOTAL KNEE ARTHROPLASTY; VENOUS THROMBOEMBOLISM