Asunto(s)
Trombosis , Tromboembolia Venosa , Humanos , Anticoagulantes/uso terapéutico , Factores de Riesgo , Trombosis/etiología , Trombosis/prevención & control , Trombosis/tratamiento farmacológico , Medición de Riesgo , Tromboembolia Venosa/tratamiento farmacológico , Tromboembolia Venosa/prevención & controlRESUMEN
Two of the more common potential complications after arthroplasty are venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolus (PE), and excess bleeding. Appropriate chemoprophylaxis choices are essential to prevent some of these adverse events and from exacerbating others. Risk stratification to prescribe safe and effective medications in the prevention of postoperative VTE has shown benefit in this regard. The Department of Orthopaedic Surgery at Syosset Hospital/Northwell Health, which performs over 1200 arthroplasties annually, has validated and is using the 2013 version of the Caprini Risk Assessment Model (RAM) to stratify each patient for risk of postoperative VTE. This tool results in a culling of information, past and present, personal and familial, that provides a truly thorough evaluation of the patient's risk for postoperative VTE. The Caprini score then guides the medication choices for thromboprophylaxis. The Caprini score is only valuable if the data is properly collected, and we have learned numerous lessons after applying it for 18 months. Risk stratification requires practice and experience to achieve expertise in perioperative patient evaluation. Having access to pertinent patient information, while gaining proficiency in completing the Caprini RAM, is vital to its efficacy. Ongoing, real time analyses of patient outcomes, with subsequent change in process, is key to improving patient care.
Asunto(s)
Artroplastia de Reemplazo/efectos adversos , Complicaciones Posoperatorias/prevención & control , Medición de Riesgo/métodos , Tromboembolia Venosa/prevención & control , Anciano , Artroplastia de Reemplazo/métodos , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/métodos , Femenino , Hemorragia/etiología , Hemorragia/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Premedicación , Tromboembolia Venosa/etiologíaRESUMEN
We conducted a retrospective cohort study (N = 477) to determine if use of intravenous tranexamic acid (TXA) improves early ambulation and reduces blood loss after total knee arthroplasty and anterior and posterior total hip arthroplasty. Mean (SD) patient age was 66.5 (10.1) years. For all 3 procedures, early ambulation was significantly better in the TXA group than in the no-TXA group at postoperative days 1 and 2, and, over time, reductions in hemoglobin and hematocrit were statistically significantly lower in the TXA group than in the no-TXA group. TXA groups required fewer postoperative transfusions. Incidence of postoperative venous thromboembolism was similar between all groups. TXA use improves early ambulation after total joint arthroplasty.
Asunto(s)
Antifibrinolíticos/uso terapéutico , Artroplastia de Reemplazo de Cadera/rehabilitación , Artroplastia de Reemplazo de Rodilla/rehabilitación , Ambulación Precoz , Ácido Tranexámico/uso terapéutico , Anciano , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Rodilla/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
In this article, we report on the differences in the healing biology of biceps tenodesis performed on either bone or soft tissue in a rat model. This work provides further insight into what may be the optimal strategy for managing biceps-labrum complex disease.