RESUMEN
BACKGROUND: Prior registry data suggest that perioperative red blood cell (RBC) transfusion may increase the incidence of venous thromboembolism (VTE) in patients status post surgery. However, there are limited data that explore VTE risk after perioperative transfusion in the setting of primary total joint arthroplasty (TJA). Our aim is to investigate the association between perioperative RBC transfusion and the development of symptomatic VTE after adjusting for confounding variables. METHODS: We retrospectively reviewed all patients undergoing primary TJA at a single institution from 2001 to 2016. The primary outcome was development of symptomatic VTE (deep vein thrombosis or pulmonary embolism) up to 90 days following primary TJA. To identify the association between RBC transfusion and development of VTE, univariate and multivariate analyses were used, as well as a sensitivity analysis using propensity score matching based on patient comorbidities. RESULTS: Of the 29,003 patients who underwent TJA, 2500 (8.62%) received RBC transfusion perioperatively and 302 (1.04%) developed a postoperative VTE within 90 days of surgery. While univariate analysis did suggest a slightly increased incidence of VTE in association with RBC transfusion (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.09-2.16), this difference was eliminated when multivariate analysis (OR, 0.42; 95% CI, 0.12-1.39) and propensity score matching (propensity-matched OR, 1.2; 95% CI, 0.7-1.8) were employed. CONCLUSION: Perioperative RBC transfusion does not significantly increase the incidence of symptomatic VTE following primary TJA in the 90-day postoperative period after adjustment for host VTE risk scores and other confounding variables. Perioperative RBC transfusion may be safely administered if indicated following total hip and knee arthroplasty.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Artroplastia de Reemplazo de Rodilla , Embolia Pulmonar , Tromboembolia Venosa , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Transfusión de Eritrocitos/efectos adversos , Humanos , Estudios Retrospectivos , Factores de Riesgo , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/etiologíaRESUMEN
ABSTRACT Objective: This study was undertaken to determine the positive rate for computed tomography pulmonary angiograms (CTPAs) at the University Hospital of the West Indies (UHWI), to compare the positive rate at the UHWI to that reported in the literature and to compare the rates of positive CTPAs between the genders. Method: Data were obtained from the databases of the Radiology Department of the UHWI. All CTPAs performed to confirm a clinical diagnosis of pulmonary embolism and the results issued during the period January 1st 2013 and December 31st 2013 inclusive were reviewed. Only initial examinations of adequate diagnostic quality were included in the study. Results: Three hundred and thirteenth CTPAs were performed for initial diagnosis of pulmonary embolism. Sixteen examinations were excluded for inadequate diagnostic quality. Two hundred and ninety-seven examinations on 223 females and 74 males were included in the study. The means for age were 49.7 years and 55.1 years, respectively; the difference in the means was significant (p < 0.05). Ninety-four examinations (31.6%) on 22 males (7.4%, mean age 58.4 years) and 72 females (24.2%, mean age 57.5 years) were positive for pulmonary embolism. The difference in the means was not significant (p = 0.8). On Chi-squared test there was no significant difference in the percentage of positive CTPAs between males and females (p = 0.7). Conclusions: The percentage of positive CTPAs at the UHWI is high. There was no significant difference between the genders in the percentage of positive CTPAs or the mean age at which pulmonary emboli were detected.
ABSTRACT Objetivo: Este estudio se llevó a cabo con el propósito de determinar la tasa positiva de las angiografías pulmonares por tomografía computarizada (APTC) en el Hospital Universitario de West Indies (UHWI), comparar la tasa positiva en el UHWI con la que se reporta en la literatura, y comparar las tasas de APTC positivas entre géneros. Método: Se obtuvieron datos de las bases del Departamento de Radiología de UHWI. Se examinaron todas las APTC realizadas para confirmar un diagnóstico clínico de embolia pulmonar y los resultados emitidos durante el período del 1ero de enero de 2013 y 31 de diciembre de 2013 inclusive. En el estudio se incluyeron únicamente exámenes iniciales de calidad diagnóstica adecuada. Resultados: Trecientos trece APTC fueron realizadas para el diagnóstico inicial de embolia pulmonar. Se excluyeron 16 exámenes por poseer una calidad diagnóstica inadecuada. Doscientos noventa y siete exámenes de 223 hembras y 74 varones fueron incluidos en el estudio. Los promedios de edad fueron 49.7 años y 55.1 años respectivamente. La diferencia de los promedios fue significativa (p < 0.05). Noventa y cuatro exámenes (31.6%) de 22 varones (7.4%, edad promedio 58.4 años) y 72 hembras (24.2%, edad promedio 57.5 años) fueron positivos a la embolia pulmonar. La diferencia de los promedios no fue significativa (p = 0.8). En la prueba de Chi-cuadrado no hubo diferencias significativas en el porcentaje de APTC positivas entre varones y hembras (p = 0.7). Conclusiones: El porcentaje de APTC positivas en el UHWI es alto. No hubo diferencias significativas de género en el porcentaje de APTC positivas o la edad promedio a la que se detectaron los émbolos pulmonares.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Embolia Pulmonar/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Factores Sexuales , Sensibilidad y Especificidad , Hospitales UniversitariosRESUMEN
Resumen ANTECEDENTES: la enfermedad tromboembólica es un cuadro clínico que puede manifestarse durante el embarazo, como un episodio aislado de trombosis venosa profunda en los miembros inferiores, o como tromboembolismo pulmonar. La prevalencia se considera baja: 1 caso por cada 1600 embarazos. El solapamiento de los síntomas de la enfermedad tromboembólica con el embarazo puede retrasar la sospecha clínica y complicar el establecimiento del diagnóstico. CASO CLÍNICO: paciente primigesta, de 37 años de edad, con un episodio de tromboembolismo pulmonar con inicio en el puerperio, asociado con trombosis venosa profunda intraparto como factor desencadenante que evolucionó favorablemente gracias al diagnóstico y tratamiento oportunos. CONCLUSIÓN: la importancia de este caso radica en la necesidad de actuar con rapidez para establecer el diagnóstico e indicar inmediatamente el tratamiento.
Abstract BACKGROUND: Venous thromboembolism (VTE) is a combination of pathologies, which can manifest during pregnancy as an isolated lower extremity deep vein thrombosis (DVT) or as a pulmonary embolus (PE). The global prevalence is low, which occurs in 1 to 1600 pregnancies. CLINICAL CASE: A 37-year-old primigravid patient with an episode of pulmonary thromboembolism with onset in the puerperium associated with intrapartum deep venous thrombosis as a triggering factor that evolved favorably due to timely diagnosis and treatment. CONCLUSION: The importance of this case lies in the need to act quickly to establish the diagnosis and immediately indicate the treatment.