Rodilla / Knee: Menos trombosis venosa profunda postartroscópica si hayprofilaxis

Deep Venous Thrombosis After Knee Arthroscopy: A Systematic Review and Meta-Analysis

Author(s): Ye Sun , Dongyang Chen , Zhihong Xu , Dongquan Shi , Jin Dai , Jianghui Qin , Jizhen Qin, Qing Jiang

Source:Arthroscopy: The Journal of Arthroscopic & Related Surgery, Volume 30, Issue 3

Purpose

To establish a contemporary literature-based estimate of the incidence of deep venous thrombosis (DVT) after knee arthroscopic surgery.

Methods

We performed a systematic review and meta-analysis of the English language literature to assess the efficacy of prophylaxis to prevent DVT after knee arthroscopic surgery. Only randomized controlled trials (RCTs) or prospective studies were considered. Studies were excluded if they were not original prospective studies concerning DVT detected by imaging after knee arthroscopic surgery. We calculated pooled proportions of postoperative DVT and proximal DVT.

Results

Nine prospective uncontrolled studies and 4 RCTs were retrieved. Within them, the populations given low-molecular-weight heparin (LMWH) to prevent DVT had a 0.1% to 11.9% incidence of DVT, with an overall 36 DVTs identified (4 proximal), averaging 1.8%. One hundred thirty-six DVTs (29 proximal) were indicated in the populations without prophylaxis, and the DVT incidence varied from 1.8% to 41.2%, averaging 6.8%. Of the RCTs, the pooled risk ratio for DVT to develop was 0.180 (range, 0.065 to 0.499) for those who had LMWH as prophylaxis. An absolute risk reduction of 1.2%—from 1.5% to 0.3%—for the development of proximal DVT was observed.

Conclusions

Compared with patients who did not receive prophylaxis, the pooled risk ratio for the development of DVT was 0.18 for those who had LMWH prophylaxis. The incidence of proximal DVT is very low after arthroscopic surgery regardless of receiving prophylaxis (4 of 2,184) or not (29 of 1,814). The rate of proximal DVT in total DVT occurrence can be markedly reduced from 21.3% (29 of 136) to 11.1% (4 of 36).

Level of Evidence

Level IV. This study is a meta-analysis of RCTs and a systematic review of Level IV studies.