title: Prevalence of Venous Thromboembolic Events Is Low in Asians After Total Knee Arthroplasty Without Chemoprophylaxis.
abstract: This retrospective cohort study was designed to establish the prevalence of clinically significant venous thromboembolic events (VTE) in our patients undergoing total knee arthroplasty (TKA) without chemoprophylaxis.
  
  
  
  A single-surgeon cohort of patients who underwent TKA from 2006 to 2014 were included. All patients had a pneumatic tourniquet applied and a drain inserted postoperatively. Tranexamic acid was not used perioperatively. All patients were under a standardized postoperative protocol with routine mechanical prophylaxis against VTE. None of the patients received prophylactic anticoagulation. All patients ambulated on the second postoperative day. Only symptomatic patients were referred for radiological examination to exclude VTE. We evaluated the patient demographics and calculated the prevalence of VTE in our cohort.
  
  
  
  A total of 966 patients were reviewed. Mean age was 66.1 ± 7.8 years. Mean body mass index was 28.2 ± 4.7 kg/m2. Mean tourniquet time was 53 ± 23 minutes. Patients stayed in hospital for a mean of 5.4 ± 3.1 days. There was 100% compliance to mechanical prophylaxis. And 11.1% of our patients were on concomitant antiplatelet or anticoagulant use. There were 8 patients with clinically significant VTE. This translates to a prevalence of 0.82%. Seven patients developed deep vein thrombosis and 1 patient died from massive pulmonary embolism.
  
  
  
  The prevalence of clinically significant VTE in our patients who underwent TKA without routine chemoprophylaxis is 0.82%. With proper patient selection, risk stratification, and stringent perioperative protocols, routine chemoprophylaxis may not be necessary in Asians undergoing TKA.
authors: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore. Electronic address: hamidrazak@gmail.com.
authors: Hamid Rahmatullah
authors: HR
authors: Bin Abd Razak
authors: Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors: Noorul Faeyza
authors: NF
authors: Binte Abd Razak
authors: Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
authors: Hwee-Chye Andrew
authors: HA
authors: Tan
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D044466:Asian People / Q000706:statistics & numerical data; D018890:Chemoprevention; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D015995:Prevalence; D011655:Pulmonary Embolism / Q000453:epidemiology; D012189:Retrospective Studies; D014111:Tourniquets; D014148:Tranexamic Acid; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology*; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology
chemical_list: D014148:Tranexamic Acid
keywords: Asian; VTE; chemoprophylaxis; complications; prevalence; total knee arthroplasty