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Characteristics, treatment patterns and outcomes of patients presenting with venous thromboembolic events after knee arthroscopy in the RIETE Registry

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Abstract

Knee arthroscopy is the most common orthopedic procedure worldwide. While incidence of post-arthroscopy venous thromboembolic events (VTE) is low, treatment patterns and patient outcomes have not been described. Patients from the “Registro Informatizado Enfermedad TromboEmbolica” who had confirmed post-arthroscopy VTE were compared to patients with provoked, post bone-fracture, and to patients with unprovoked VTE. Baseline characteristics, presenting signs and symptoms, treatment and outcomes including recurrent VTE, bleeds or death were compared. A total of 101 patients with post-arthroscopy VTE and 19,218 patients with unprovoked VTE were identified. Post-arthroscopy patients were younger (49.5 vs. 66 years, P < 0.0001) and had less history of VTE [5.9% vs. 20%, OR 0.26 (0.11–0.59)]. Among patients with isolated DVT, there were fewer proximal DVT in the post-arthroscopy group [40% vs. 86%, OR 0.11 (0.06–0.19)]. Treatment duration was shorter in the post-arthroscopy group (174 ± 140 vs. 311 ± 340 days, P < 0.0001) and more often with DOAC [OR 3.67 (1.95–6.89)]. Recurrent VTE occurred in 6.18 (1.96–14.9) and 11.9 (11.0–12.8) per 100 patient years [HR 0.52 (0.16–1.26)] after treatment in the post-arthroscopy and unprovoked groups, respectively. Recurrent VTE occurred in 5.17 (1.31–14.1) per 100 patient years in a separate post bone-fracture group (n = 147), also not statistically different than the post-arthroscopy recurrence rate. After anticoagulation cessation, some patients post-knee arthroscopy develop VTE. While our small sample size precludes drawing firm conclusions, this signal should warrant further research into the optimal treatment duration for these patients, as some patients may be at increased risk for long-term recurrence.

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Acknowledgements

We express our gratitude to Sanofi Spain for supporting this Registry with an unrestricted educational grant. We also express our gratitude to Bayer Pharma AG for supporting this Registry. Bayer Pharma AG’s support was limited to the part of RIETE outside Spain, which accounts for a 25.02% of the total patients included in the RIETE Registry. We also thank the RIETE Registry Coordinating Center, S&H Medical Science Service, for their quality control data, logistic and administrative support and Prof. Salvador Ortiz, Universidad Autónoma Madrid and Silvia Galindo, both Statistical Advisors in S&H Medical Science Service for the statistical analysis of the data presented in this paper.

Coordinator of the RIETE Registry: Dr. Manuel Monreal (Spain). RIETE Steering Committee Members: Dr. Paolo Prandoni (Italy), Dr. Benjamin Brenner (Israel), Dr. Dominique Farge-Bancel (France). RIETE National Coordinators: Dr. Raquel Barba (Spain), Dr. Pierpaolo Di Micco (Italy), Dr. Laurent Bertoletti (France), Dr. Inna Tzoran (Israel), Dr. Abilio Reis (Portugal), Dr. Henri Bounameaux (Switzerland), Dr. Radovan Malý (Czech Republic), Dr. Peter Verhamme (Belgium), Dr. Marijan Bosevski (Republic of Macedonia), Dr. Joseph A. Caprini (USA), Dr. Hanh My Bui (Vietnam). RIETE Registry Coordinating Center: S & H Medical Science Service. Members of the RIETE Group: Spain: Adarraga MD, Agudo P, Aibar MA, Aibar J, Amado C, Akasbi M, Aranda C, Arcelus JI, Arenas A, Ballaz A, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Blanco-Molina A, Camon AM, Carrasco C, Castro J, Cruz AJ, de Ancos C, del Toro J, Demelo P, Díaz-Pedroche MC, Díaz-Peromingo JA, Falgá C, Farfán AI, Fernández-Capitán C, Fidalgo MA, Font C, Font L, García MA, García-Bragado F, García-Morillo M, García-Raso A, Gavín O, Gayol MC, Gil-Díaz A, Gómez V, González-Martínez J, Grau E, Gutiérrez J, Hernández-Blasco L, Iglesias M, Jara-Palomares L, Jaras MJ, Jiménez D, Jou I, Joya MD, Lalueza A, Lima J, Llamas P, Lobo JL, López-Jiménez L, López-Miguel P, López-Nuñez JJ, López-Reyes R, López-Sáez JB, Lorente MA, Lorenzo A, Loring M, Loscos S, Lumbierres M, Marchena PJ, Martín-Fernández M, Martín-Guerra JM, Martín-Romero M, Mellado M, Modesto M, Monreal M, Morales MV, Nieto JA, Núñez A, Núñez MJ, Olivares MC, Otalora S, Otero R, Pedrajas JM, Pellejero G, Pérez-Jacoiste A, Pérez-Rus G, Peris ML, Pesce ML, Porras JA, Rivas A, Rodríguez-Dávila MA, Rodríguez-Fernández L, Rodríguez-Hernández A, Rosa V, Rosillo-Hernández EM, Rubio CM, Ruiz-Alcaraz S, Ruiz-Artacho P, Ruiz-Ruiz J, Ruiz-Sada P, Sahuquillo JC, Sampériz A, Sánchez-Muñoz-Torrero JF, Sancho T, Sanoja ID, Soler S, Soto MJ, Suriñach JM, Tapia E, Torres MI, Trujillo-Santos J, Uresandi F, Usandizaga E, Valle R, Vela JR, Vilar C, Argentina: Gutiérrez P, Vázquez FJ, Vilaseca A, Belgium: Vanassche T, Vandenbriele C, Verhamme P, Brazil: Yoo HHB, Czech Republic: Hirmerova J, Malý R, Ecuador: Salgado E, France: Benzidia I, Bertoletti L, Bura-Riviere A, Debourdeau P, Falvo N, Farge-Bancel D, Hij A, Mahé I, Moustafa F, Israel: Braester A, Brenner B, Ellis M, Tzoran I, Italy: Barillari G, Bilora F, Bortoluzzi C, Brandolin B, Bucherini E, Camerota A, Ciammaichella M, Dentali F, Di Micco P, Grandone E, Imbalzano E, Lessiani G, Maida R, Mastroiacovo D, Ngoc V, Pace F, Parisi R, Pesavento R, Pinelli M, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Sotgiu P, Tufano A, Visonà A, LATVIA: Gibietis V, Skride A, Strautmane S, Republic of Macedonia: Bosevski M, Zdraveska M, Switzerland: Bounameaux H, Mazzolai L, USA: Caprini J, Vietnam: Bui HM.

Funding

This study was funded by Sanofi Spain with an unrestricted educational grant and Bayer Pharma AG. Bayer Pharma AG’s support was limited to the part of RIETE outside Spain, which accounts for a 25.02% of the total patients included in the RIETE Registry.

Author information

Authors and Affiliations

  1. Vascular Medicine, Division of Cardiology, Fireman Vascular Center, Massachusetts General Hospital, 55 Fruit Street, GRB-852G, Boston, MA, 02114, USA

    Ido Weinberg

  2. Division of Cardiology, Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA

    Jay Giri

  3. OhioHealth Vascular Institute, Ohio Health, Columbus, OH, USA

    Raghu Kolluri

  4. Department of General Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain

    Juan Ignacio Arcelus & J. I. Arcelus

  5. Department of Internal Medicine, Hospital de Mataró, Barcelona, Spain

    Conxita Falgá & C. Falgá

  6. Department of Internal Medicine, Hospital Olot i Comarcal de la Garrotxa, Girona, Spain

    Silvia Soler & S. Soler

  7. Department of Haematology, Galilee Medical Center, Nahariya, Israel

    Andrei Braester & A. Braester

  8. Department of Internal Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain

    José Bascuñana & J. Bascuñana

  9. Department of Internal Medicine, Hospital Monográfico ASEPEYO, Madrid, Spain

    Javier Gutiérrez-Guisado

  10. Universidad Francisco de Vitoria, Madrid, Spain

    Javier Gutiérrez-Guisado

  11. Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain

    Manuel Monreal & M. Monreal

  12. Universidad Católica de Murcia, Murcia, Spain

    Manuel Monreal & M. Monreal

Authors
  1. Ido Weinberg
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  2. Jay Giri
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  3. Raghu Kolluri
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  4. Juan Ignacio Arcelus
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  5. Conxita Falgá
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  6. Silvia Soler
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  8. José Bascuñana
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  9. Javier Gutiérrez-Guisado
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Consortia

RIETE Investigators

  • M. D. Adarraga
  • , P. Agudo
  • , M. A. Aibar
  • , J. Aibar
  • , C. Amado
  • , M. Akasbi
  • , C. Aranda
  • , J. I. Arcelus
  • , A. Arenas
  • , A. Ballaz
  • , R. Barba
  • , M. Barrón
  • , B. Barrón-Andrés
  • , J. Bascuñana
  • , A. Blanco-Molina
  • , A. M. Camon
  • , C. Carrasco
  • , J. Castro
  • , A. J. Cruz
  • , C. de Ancos
  • , J. del Toro
  • , P. Demelo
  • , M. C. Díaz-Pedroche
  • , J. A. Díaz-Peromingo
  • , C. Falgá
  • , A. I. Farfán
  • , C. Fernández-Capitán
  • , M. A. Fidalgo
  • , C. Font
  • , L. Font
  • , M. A. García
  • , F. García-Bragado
  • , M. García-Morillo
  • , A. García-Raso
  • , O. Gavín
  • , M. C. Gayol
  • , A. Gil-Díaz
  • , V. Gómez
  • , J. González-Martínez
  • , E. Grau
  • , J. Gutiérrez
  • , L. Hernández-Blasco
  • , M. Iglesias
  • , L. Jara-Palomares
  • , M. J. Jaras
  • , D. Jiménez
  • , I. Jou
  • , M. D. Joya
  • , A. Lalueza
  • , J. Lima
  • , P. Llamas
  • , J. L. Lobo
  • , L. López-Jiménez
  • , P. López-Miguel
  • , J. J. López-Nuñez
  • , R. López-Reyes
  • , J. B. López-Sáez
  • , M. A. Lorente
  • , A. Lorenzo
  • , M. Loring
  • , S. Loscos
  • , M. Lumbierres
  • , P. J. Marchena
  • , M. Martín-Fernández
  • , J. M. Martín-Guerra
  • , M. Martín-Romero
  • , M. Mellado
  • , M. Modesto
  • , M. Monreal
  • , M. V. Morales
  • , J. A. Nieto
  • , A. Núñez
  • , M. J. Núñez
  • , M. C. Olivares
  • , S. Otalora
  • , R. Otero
  • , J. M. Pedrajas
  • , G. Pellejero
  • , A. Pérez-Jacoiste
  • , G. Pérez-Rus
  • , M. L. Peris
  • , M. L. Pesce
  • , J. A. Porras
  • , A. Rivas
  • , M. A. Rodríguez-Dávila
  • , L. Rodríguez-Fernández
  • , A. Rodríguez-Hernández
  • , V. Rosa
  • , E. M. Rosillo-Hernández
  • , C. M. Rubio
  • , S. Ruiz-Alcaraz
  • , P. Ruiz-Artacho
  • , J. Ruiz-Ruiz
  • , P. Ruiz-Sada
  • , J. C. Sahuquillo
  • , A. Sampériz
  • , J. F. Sánchez-Muñoz-Torrero
  • , T. Sancho
  • , I. D. Sanoja
  • , S. Soler
  • , M. J. Soto
  • , J. M. Suriñach
  • , E. Tapia
  • , M. I. Torres
  • , J. Trujillo-Santos
  • , F. Uresandi
  • , E. Usandizaga
  • , R. Valle
  • , J. R. Vela
  • , C. Vilar
  • , P. Gutiérrez
  • , F. J. Vázquez
  • , A. Vilaseca
  • , T. Vanassche
  • , C. Vandenbriele
  • , P. Verhamme
  • , H. H. B. Yoo
  • , J. Hirmerova
  • , R. Malý
  • , E. Salgado
  • , I. Benzidia
  • , L. Bertoletti
  • , A. Bura-Riviere
  • , P. Debourdeau
  • , N. Falvo
  • , D. Farge-Bancel
  • , A. Hij
  • , I. Mahé
  • , F. Moustafa
  • , A. Braester
  • , B. Brenner
  • , M. Ellis
  • , I. Tzoran
  • , G. Barillari
  • , F. Bilora
  • , C. Bortoluzzi
  • , B. Brandolin
  • , E. Bucherini
  • , A. Camerota
  • , M. Ciammaichella
  • , F. Dentali
  • , P. Di Micco
  • , E. Grandone
  • , E. Imbalzano
  • , G. Lessiani
  • , R. Maida
  • , D. Mastroiacovo
  • , V. Ngoc
  • , F. Pace
  • , R. Parisi
  • , R. Pesavento
  • , M. Pinelli
  • , P. Prandoni
  • , R. Quintavalla
  • , A. Rocci
  • , C. Siniscalchi
  • , P. Sotgiu
  • , A. Tufano
  • , A. Visonà
  • , V. Gibietis
  • , A. Skride
  • , S. Strautmane
  • , M. Bosevski
  • , M. Zdraveska
  • , H. Bounameaux
  • , L. Mazzolai
  • , J. Caprini
  •  & H. M. Bui

Corresponding author

Correspondence to Ido Weinberg.

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Conflict of interest

Ido Weinberg serves on the Scientific Advisory Board, Novate Medical. Jay Giri serves on the Board of Directors for PERT Consortium, a 501c3 not-for-profit organization. Raghu Kolluri serves on the Board of Directors for VIVA Physicians Inc, a 501c3 not-for-profit organization. He is a paid consultant or serves on the Advisory Board for Medtronic, Philips/Volcano, BTG, Janssen, Vesper Medical, Innovein, Spectranetics, Inari, Boston Scientific. He has received research support from BTG. Juan Ignacio Arcelus, Conxita Falgá, Silvia Soler, Andrei Braester, José Bascuñana, Javier Gutiérrez-Guisado and Manuel Monreal declares no conflicts of interests.

Informed consent

Participating centers have local Institutional Review Board approval with patients providing informed consent for registry enrollment.

Additional information

A full list of the RIETE investigators is given in Acknowledgements section.

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Weinberg, I., Giri, J., Kolluri, R. et al. Characteristics, treatment patterns and outcomes of patients presenting with venous thromboembolic events after knee arthroscopy in the RIETE Registry. J Thromb Thrombolysis 46, 551–558 (2018). https://doi.org/10.1007/s11239-018-1736-9

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  • DOI: https://doi.org/10.1007/s11239-018-1736-9

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