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The Incidence of Pulmonary Embolism and Deep Vein Thrombosis After Knee Arthroplasty in Asians Remains Low: A Meta-analysis

  • Symposium: Special Considerations for TKA in Asian Patients
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

While Western literature has mostly reported the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) after TKA with chemoprophylaxis, the Asian literature still has mostly reported the incidence without chemoprophylaxis. This may reflect a low incidence of DVT and PE in Asian patients, although some recent studies suggest the incidence after TKA in Asian patients is increasing. Moreover, it is unclear whether the incidence of DVT and PE after TKA is similarly low among different Asian countries.

Questions/purposes

We therefore determined the overall incidence of symptomatic PE and DVT without chemoprophylaxis after TKA in the Asian population, determined whether the incidence had a tendency to increase over time in Asia, and compared the incidence of symptomatic PE and DVT among Asian countries through a meta-analysis.

Methods

We searched the PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar websites for prospective studies published between 1996 and 2011. A total of 1947 patients from 18 studies were reviewed for meta-analysis.

Results

The incidence of symptomatic PE was 0.01%. The incidences of overall DVT, proximal DVT, and symptomatic DVT were 40.4%, 5.8% and 1.9%, respectively. We found no difference in incidence of symptomatic PE among Asian countries and no trends in changes of the incidence over time.

Conclusions

The incidence of symptomatic PE and DVT after TKA without prophylaxis is low in Asian countries and has not changed over time, despite Westernizing lifestyles and an aging populace. Further investigation with large randomized studies is necessary to confirm our findings and identify risk factors predisposing to DVT.

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Acknowledgments

This study was performed as an effort of the task force team for DVT prevention guidelines of Korean Knee Society and the authors sincerely thank Hyunsun Lim, PhD, Biostatistics Collaboration Unit, Gangnam Severance Hospital Biomedical Research Center, for her contribution to statistical analysis.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Korea

    Woo-Suk Lee MD, PhD

  2. Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, 149 Sangil-dong, Gangdong-gu, Seoul, 134-090, Korea

    Kang-Il Kim MD, PhD

  3. Department of Orthopaedic Surgery, Choong-Ang University Hospital, Seoul, Korea

    Han-Jun Lee MD, PhD

  4. Department of Orthopaedic Surgery, Kyung Pook National University Hospital, Daegu, Korea

    Hee-Soo Kyung MD, PhD

  5. Department of Orthopaedics, Bumin Hospital, Busan, Korea

    Seung-Suk Seo MD, PhD

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  1. Woo-Suk Lee MD, PhD
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Corresponding author

Correspondence to Kang-Il Kim MD, PhD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved or waived approval for the reporting of this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Kyung Hee University Hospital at Gangdong (Seoul, Korea) and Yonsei University Gangnam Severance Hospital (Seoul, Korea).

Appendix 1

Appendix 1

Search Strategy Applied to Titles and Abstracts

“venous thromboembolism” OR “deep vein thrombosis” OR “pulmonary embolism”

AND

“total knee arthroplasty” OR “total knee replacement” OR “total knee replacement arthroplasty”

AND

“Asia” OR “Asian” OR “Asian country” OR “Korea” OR “China” OR “Hong Kong” OR “Taiwan” OR “Japan” OR “Mongolia” OR “Bangladesh” OR “Cambodia” OR “India” OR “Indonesia” OR “Laos” OR “Malaysia” OR “Myanmar” OR “Nepal” OR “Pakistan” OR “Philippines” OR “Singapore” OR “Sri Lanka” OR “Thailand” OR “Vietnam” OR “Kazakhstan” OR “Kyrgyzstan” OR “Tajikistan” OR “Turkmenistan” OR “Uzbekistan” OR “Afghanistan” OR “Bahrain” OR “Iran” OR “Iraq” OR “Israel” OR “Jordan” OR “Kuwait” OR “Lebanon” OR “Oman” OR “Qatar” OR “Saudi Arabia” OR “Syria” OR “UAE” OR “Yemen”

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Lee, WS., Kim, KI., Lee, HJ. et al. The Incidence of Pulmonary Embolism and Deep Vein Thrombosis After Knee Arthroplasty in Asians Remains Low: A Meta-analysis. Clin Orthop Relat Res 471, 1523–1532 (2013). https://doi.org/10.1007/s11999-012-2758-9

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  • DOI: https://doi.org/10.1007/s11999-012-2758-9

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