Document Detail


Meta-analysis of cause of death following total joint replacement using different thromboprophylaxis regimens.
MedLine Citation:
PMID:  22219258     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
We performed a meta-analysis of modern total joint replacement (TJR) to determine the post-operative mortality and the cause of death using different thromboprophylactic regimens as follows: 1) no routine chemothromboprophylaxis (NRC); 2) Potent anticoagulation (PA) (unfractionated or low-molecular-weight heparin, ximelagatran, fondaparinux or rivaroxaban); 3) Potent anticoagulation combined (PAC) with regional anaesthesia and/or pneumatic compression devices (PCDs); 4) Warfarin (W); 5) Warfarin combined (WAC) with regional anaesthesia and/or PCD; and 6) Multimodal (MM) prophylaxis, including regional anaesthesia, PCDs and aspirin in low-risk patients. Cause of death was classified as autopsy proven, clinically certain or unknown. Deaths were grouped into cardiopulmonary excluding pulmonary embolism (PE), PE, bleeding-related, gastrointestinal, central nervous system, and others (miscellaneous). Meta-analysis based on fixed effects or random effects models was used for pooling incidence data. In all, 70 studies were included (99 441 patients; 373 deaths). The mortality was lowest in the MM (0.2%) and WC (0.2%) groups. The most frequent cause of death was cardiopulmonary (47.9%), followed by PE (25.4%) and bleeding (8.9%). The proportion of deaths due to PE was not significantly affected by the thromboprophylaxis regimen (PA, 35.5%; PAC, 28%; MM, 23.2%; and NRC, 16.3%). Fatal bleeding was higher in groups relying on the use of anticoagulation (W, 33.8%; PA, 9.4%; PAC, 10.8%) but the differences were not statistically significant. Our study demonstrated that the routine use of PA does not reduce the overall mortality or the proportion of deaths due to PE.
Authors:
L A Poultsides; A Gonzalez Della Valle; S G Memtsoudis; Y Ma; T Roberts; N Sharrock; E Salvati
Related Documents :
15937708 - Pelvi-calyceal height, a predictor of success when treating lower pole stones with extr...
19362338 - Shock wave lithotripsy versus semirigid ureteroscopy for proximal ureteral calculi (<20...
8934088 - Endoscopic papillary balloon dilation in cirrhotic patients: removal of common bile duc...
18355138 - Effects of prophylactic insertion of double-j stents to decrease episodes of renal coli...
25227868 - Acute procedural and cryoballoon characteristics from cryoablation of atrial fibrillati...
23075518 - Effects of age on outcome in the sentis trial: better outcomes in elderly patients.
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of bone and joint surgery. British volume     Volume:  94     ISSN:  0301-620X     ISO Abbreviation:  J Bone Joint Surg Br     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-01-05     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375355     Medline TA:  J Bone Joint Surg Br     Country:  England    
Other Details:
Languages:  eng     Pagination:  113-21     Citation Subset:  AIM; IM    
Affiliation:
Hospital for Special Surgery, 535 East 70th Street, New York, New York 10021, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Early antibiotics and debridement independently reduce infection in an open fracture model.
Next Document:  The treatment of locally recurrent chondrosarcoma: Is extensive further surgery justified?