ＴＫＡ周術期におけるＶＴＥの検討
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概要
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Objective: We investigated the efficacy of our protocols for preventing venous thromboembolism (VTE) using physical therapy and unfractionated heparin.Methods: Between 2006 and 2008, total knee arthroplasty (TKA) was performed on 129 joints in 117 patients (19 joints in 17 men and 110 joints in 100 women; average age, 72.8 years; 99 joints in patients with osteoarthritis, 30 joints in patients with rheumatoid arthritis). All patients were treated with unfractionated heparin (100 U/kg per day, continuous intravenous drip injection for 10 days) immediately after surgery in addition to undergoing physical therapy. The D-dimer levels were measured preoperatively and postoperatively on days 1, 3, 6, 10, and 14. VTE was diagnosed using lower extremity venous ultrasonography and multidetector row computed tomography (MDCT) when the D-dimer level increased to more than 10 µg/ml.Results: The incidence of VTE was 20.9% among patients who underwent primary TKA. Pulmonary embolism (PE) was detected in seven patients (5.4%), but none of the lesions were symptomatic. A significant increase (P<0.05) in the D-dimer levels on postoperative days 6, 10, and 14 were observed in patients with VTE. The preoperative D-dimer levels were significantly higher (P<0.05) in patients with rheumatoid arthritis than in those with osteoarthritis. All seven patients diagnosed as having PE were affected with calf-type deep vein thrombosis (DVT), and six of these patients had soleal vein thrombosis. Regarding the factors associated with VTE, the only significant difference (P<0.05) that was observed was that the occurence of VTE in the operative limb was significantly greater than that in the nonoperative limb.Conclusion: Unfractionated heparin administration in combination with physical therapy was useful for preventing VTE after TKA, and changes in the D-dimer levels were relevant to the onset of VTE. Even in cases with calf-type DVT, attention should be given to the possibility of an increased risk of PE.
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