Ítem
Acceso Abierto

Primary Joint Arthroplasty Surgery: Is the Risk of Major Bleeding Higher in Elderly Patients? A Retrospective Cohort Study

Mostrar el registro sencillo de la publicación
dc.contributor.advisorBonilla, Guillermo
dc.creatorQuintero, Jorge
dc.creatorCardenas, Laura L.
dc.creatorNavas, Mónica
dc.creatorBautista, María Piedad
dc.creatorBonilla, Guillermo
dc.creator.degreeEspecialista en Ortopedia y Traumatología FSFB
dc.date.accessioned2016-08-01T15:59:01Z
dc.date.available2016-08-01T15:59:01Z
dc.date.created2016-04-04
dc.date.issued2016
dc.description.abstractIncreased risk of bleeding after major orthopedic surgery (MOS) has been widely documented in general population. However, this complication has not been studied in elderly patients. The purpose of this study is to determine whether the risk of major bleeding after MOS is higher in elderly patients, compared with those operated at a younger age. Methods: This retrospective cohort study included total hip and total knee arthroplasty patients operated during 5 consecutive years. The main outcome was the occurrence of major bleeding. Patients with other causes of bleeding were excluded. Relative risks (RRs) and confidence intervals (CIs) were calculated, anda multivariate analysis was performed. Results: A total of 1048 patients were included, 56% of patients were hip arthroplasties. At the time of surgery, 553 (53%) patients were older than 70 years. Patients aged >70 years showed an increased risk of major bleeding (RR: 2.42 [95% CI: 1.54-3.81]). For hip arthroplasty, the RR of bleeding was 2.61 (95%CI: 1.50-4.53) and 2.25 (95% CI: 1.03-4.94) for knee arthroplasty. After multivariate analysis, age was found to be independently associated with higher risk of major bleeding. Conclusion: According to European Medicines Agency criteria, patients aged 70 years are at a higher risk of major bleeding after MOS, result of a higher frequency of blood transfusions in this group of patients. Standardized protocols for blood transfusion in these patients are still required.eng
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.48713/10336_12280
dc.identifier.urihttp://repository.urosario.edu.co/handle/10336/12280
dc.language.isospa
dc.publisherUniversidad del Rosariospa
dc.publisher.departmentFacultad de Medicinaspa
dc.publisher.programEspecialización en Ortopedia y Traumatología FSFBspa
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto completo)spa
dc.rights.ccAtribución-NoComercial-SinDerivadas 2.5 Colombiaspa
dc.rights.licenciaEL AUTOR, manifiesta que la obra objeto de la presente autorización es original y la realizó sin violar o usurpar derechos de autor de terceros, por lo tanto la obra es de exclusiva autoría y tiene la titularidad sobre la misma. PARGRAFO: En caso de presentarse cualquier reclamación o acción por parte de un tercero en cuanto a los derechos de autor sobre la obra en cuestión, EL AUTOR, asumirá toda la responsabilidad, y saldrá en defensa de los derechos aquí autorizados; para todos los efectos la universidad actúa como un tercero de buena fe. EL AUTOR, autoriza a LA UNIVERSIDAD DEL ROSARIO, para que en los términos establecidos en la Ley 23 de 1982, Ley 44 de 1993, Decisión andina 351 de 1993, Decreto 460 de 1995 y demás normas generales sobre la materia, utilice y use la obra objeto de la presente autorización. -------------------------------------- POLITICA DE TRATAMIENTO DE DATOS PERSONALES. Declaro que autorizo previa y de forma informada el tratamiento de mis datos personales por parte de LA UNIVERSIDAD DEL ROSARIO para fines académicos y en aplicación de convenios con terceros o servicios conexos con actividades propias de la academia, con estricto cumplimiento de los principios de ley. Para el correcto ejercicio de mi derecho de habeas data cuento con la cuenta de correo habeasdata@urosario.edu.co, donde previa identificación podré solicitar la consulta, corrección y supresión de mis datos.spa
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/2.5/co/
dc.source.bibliographicCitationTaylor JM, Gropper MA. Critical care challenges in orthopedic surgery patients. Crit Care Med 2006;34:S191.
dc.source.bibliographicCitationOberweis BS, Nukala S, Rosenberg A, et al. Thrombotic and bleeding complications after orthopedic surgery. Am Heart J 2013;165:427.
dc.source.bibliographicCitationL opez-Jim enez L, Montero M, Gonz alez-Fajardo JA, et al. Venous thromboembolism in very elderly patients: findings from a prospective registry (RIETE). Haematologica 2006;91:1046
dc.source.bibliographicCitationBauersachs RM. Use of anticoagulants in elderly patients. Thromb Res 2012;129:107.
dc.source.bibliographicCitationWaddell J, Johnson K, HeinW, et al. Orthopedic practice in total hip arthroplasty and total knee arthroplasty: results from the Global Orthopaedic Registry (GLORY). Am J Orthop 2010;39:5.
dc.source.bibliographicCitationSchulman S, Beyth RJ, Kearon C, et al. Hemorrhagic complications of anticoagulant and thrombolytic treatment: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 2008;133:257.
dc.source.bibliographicCitationPineo GF, Gallus AS, Raskob GE, et al. Apixaban after hip or knee arthroplasty versus enoxaparin: efficacy and safety in key clinical subgroups. J Thromb Haemost 2013;11:444.
dc.source.bibliographicCitationGuerin S, Collins C, Kapoor H, et al. Blood transfusion requirement prediction in patients undergoing primary total hip and knee arthroplasty. Transfus Med 2007;17:37.
dc.source.bibliographicCitationCao YB, Zhang JD, Shen H, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total hip or knee arthroplasty: a meta-analysis of randomized controlled trials. Eur J Clin Pharmacol 2010;66:1099.
dc.source.bibliographicCitationFalck-Ytter Y, Francis C, Johanson N, et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012;141:e278S.
dc.source.bibliographicCitationEuropean Medicines Agency. Committee for Medical Products for Human Use (CHMP). Guideline on clinical investigation of medicinal products for prevention of venous thromboembolism (VTE) in patients undergoing high VTE-risk surgery. vol. May. 2013.
dc.source.bibliographicCitationPola E, Papaleo P, Santoliquido A, et al. Clinical factors associated with an increased risk of perioperative blood transfusion in nonanemic patients undergoing total hip arthroplasty. J Bone Joint Surg Am 2004;86-A:57.
dc.source.bibliographicCitationAhmed I, Chan JKK, Jenkins P, et al. Estimating the transfusion risk following total knee arthroplasty. Orthopedics 2012;35:e1465.
dc.source.bibliographicCitationWattanakit K, Cushman M, Stehman-Breen C, et al. Chronic kidney disease increases risk for venous thromboembolism. J Am Soc Nephrol 2008;19:135.
dc.source.bibliographicCitationBozic K, Chiu V, Slover J. Health state utility in patients with osteoarthritis of the hip and total hip arthroplasty. J Arthroplast 2011;26:129.
dc.source.bibliographicCitationBozic KJ, Maselli J, Pekow PS, et al. The influence of procedure volumes and standardization of care on quality and efficiency in total joint replacement surgery. J Bone Joint Surg Am 2010;92:2643.
dc.source.bibliographicCitationNieto J, Garrido-Espada N, Gujiarro-Merino R, et al. Dabigatran, rivaroxaban and apixaban versus enoxaparin for thromboprophylaxis after total knee or hip arthroplasty: pool-analysis of phase III randomized clinical trials. Thromb Res 2012;130:183.
dc.source.bibliographicCitationG omez-Outes A, Terleira-Fern andez A, Su arez-Gea M, et al. Dabigatran, rivaroxaban, or apixaban versus enoxaparin for thromboprophylaxis after total hip or knee replacement: systematic review, meta-analysis, and. BMJ Br Med 2012;3675:1.
dc.source.bibliographicCitationLassen MR, Raskob GE, Gallus A, et al. Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomised doubleblind trial. Lancet 2010;375:807.
dc.source.bibliographicCitationLassen M, Gallus A, Raskob GE, et al. Apixaban versus enoxaparin for thromboprophylaxis after hip replacement. N Engl J Med 2010;363:2487
dc.source.bibliographicCitationKakkar A, Brenner B, Dahl O, et al. Extended duration rivaroxaban versus shortterm enoxaparin for the prevention of venous thromboebolism after total hip arthroplasty: a double-blind, randomised controlled trial. Lancet 2008;372:31.
dc.source.bibliographicCitationTurpie AGG, Lassen MR, Davidson BL, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial. Lancet 2009;373:1673.
dc.source.bibliographicCitationLassen M, Ageno W, Borris L, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med 2008;358: 2776.
dc.source.bibliographicCitationSiguret V, Gouin-Thibault I, Gaussem P, et al. Optimizing the use of anticoagulants (heparins and oral anticoagulants) in the elderly. Drugs Aging 2013;30: 687.
dc.source.bibliographicCitationColwell CW, Hardwick ME. Thromboprophylaxis in elderly patients undergoing major orthopaedic surgery. Drugs Aging 2008;25:551.
dc.source.bibliographicCitationSamama MM. Use of low-molecular-weight heparins and new anticoagulants in elderly patients with renal impairment. Drugs Aging 2011;28:177.
dc.source.bibliographicCitationWarwick D, Friedman RJ, Agnelli G, et al. Insufficient duration of venous thromboembolism prophylaxis after total hip or knee replacement when compared with the time course of thromboembolic events: findings from the Global Orthopaedic Registry. J Bone Joint Surg Br 2007;89:799
dc.source.bibliographicCitationHull RD, Pineo GF, Stein PD, et al. Extended out-of-hospital low-molecularweight heparin prophylaxis against deep venous thrombosis in patients after elective hip arthroplasty: a systematic review. Ann Intern Med 2001;135:858.
dc.source.bibliographicCitationEikelboom JW, Quinlan DJ, Douketis JD. Extended-duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of the randomised trials. Lancet (London, England) 2001;358:9.
dc.source.bibliographicCitationShorr A, Eriksson B, Jaffer A, et al. Impact of stage 3B chronic kidney disease on thrombosis and bleeding outcomes after orthopedic surgery in patients treated with desirudin or enoxaparin: insights from a randomized trial. J Thromb Haemost 2012;10:1515
dc.source.instnameinstname:Universidad del Rosariospa
dc.source.reponamereponame:Repositorio Institucional EdocURspa
dc.subject.ddcVarias ramas de la medicina, Cirugía
dc.subject.decsOrtopediaspa
dc.subject.decsArtroplastiaspa
dc.subject.decsArticulación de la Caderaspa
dc.subject.decsArticulación de la Rodillaspa
dc.subject.decsAnticoagulantesspa
dc.subject.keywordAgedeng
dc.subject.keywordAnticoagulantseng
dc.subject.keywordArthoplastyeng
dc.subject.keywordHipeng
dc.subject.keywordKneeeng
dc.subject.keywordPostoperative hemorrhageeng
dc.titlePrimary Joint Arthroplasty Surgery: Is the Risk of Major Bleeding Higher in Elderly Patients? A Retrospective Cohort Studyspa
dc.typemasterThesiseng
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.type.spaTrabajo de gradospa
Archivos
Bloque original
Mostrando1 - 1 de 1
Miniatura
Nombre:
Quintero-Jorge-2016.pdf
Tamaño:
587.73 KB
Formato:
Adobe Portable Document Format
Descripción:
Descargar
Colecciones
Especialización en Ortopedia y Traumatología FSFB