title: Incidence and Fate of "Symptomatic" Venous Thromboembolism After Knee Arthroplasty Without Pharmacologic Prophylaxis in an Asian Population.
abstract: As the possibility of developing complications after an "asymptomatic" venous thromboembolism (VTE) after total knee arthroplasty (TKA) has been reported very low, "symptomatic" VTEs seem to be the real concern among orthopedic surgeons. Therefore, the purpose of this study was to determine the incidence of "symptomatic" VTEs and the fate of "symptomatic" VTEs after anticoagulation therapy and assess whether routine pharmacologic prophylaxis is necessary in TKA patients.
  
  
  
  We retrospectively reviewed 2891 consecutive TKAs in 1933 patients. Graduated compression stockings and intermittent pneumatic calf compression devices were used for VTE prophylaxis. The incidence of symptomatic VTE was investigated until 6 months postoperatively. Patients with VTE underwent anticoagulation therapy and followed up to evaluate range of motion, knee society score, Western Ontario and McMaster Universities index scores, and the presence of any complications (mean follow-up period, 3.6 years).
  
  
  
  Fifty-three (1.83%) of the 2891 TKAs had suggestive symptoms and/or sign of VTE. Of these 53 cases, 26 (0.90%) were diagnosed as symptomatic VTE, which comprised 10 (0.35%) symptomatic deep venous thromboses, 11 (0.38%) symptomatic pulmonary embolisms (PEs), 5 (0.17%) symptomatic deep venous thromboses combined with PEs, and no fatal PE. There was no significant difference in range of motion, knee society score, and Western Ontario and McMaster Universities index scores between the groups with or without symptomatic VTE. When treated properly after the diagnosis of symptomatic VTE, no specific complications were identified.
  
  
  
  Symptomatic VTEs are rare in patients who undergo TKAs with mechanical prophylaxis only. Patients with symptomatic VTEs after TKA can be treated without significant sequelae once they are properly treated with anticoagulation after the diagnosis.
authors.affiliation: Department of Orthopedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, South Korea.
authors.forename: Yong-Geun
authors.initials: YG
authors.lastname: Park
authors.affiliation: Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Chul-Won
authors.initials: CW
authors.lastname: Ha
authors.affiliation: Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Sung Sahn
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Aseem Arif
authors.initials: AA
authors.lastname: Shaikh
authors.affiliation: Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Yong-Beom
authors.initials: YB
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D044466:Asian People; D005260:Female; D006801:Humans; D015994:Incidence; D048228:Intermittent Pneumatic Compression Devices; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000453:epidemiology; D012189:Retrospective Studies; D053828:Stockings, Compression; D054556:Venous Thromboembolism / Q000209:etiology*; D020246:Venous Thrombosis / Q000209:etiology*
chemical_list: D000925:Anticoagulants
keywords: VTE prophylaxis; symptomatic DVT; symptomatic PE; symptomatic VTE; total knee arthroplasty