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      Incidences of deep vein thrombosis and major bleeding under the administration of fondaparinux for thromboprophylaxis after periacetabular osteotomy: a retrospective observational study

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          ABSTRACT

          Periacetabular osteotomy (PAO) is an effective joint-preserving procedure for patients with developmental dysplasia of the hip. Although deep vein thrombosis (DVT) is considered a serious complication of orthopaedic surgery, there is no consensus regarding a thromboprophylaxis strategy after PAO. We have routinely administered fondaparinux for DVT prophylaxis in adult patients undergoing PAO. The aim of this study was to investigate the incidences of DVT and major bleeding under the administration of fondaparinux for thromboprophylaxis after PAO. A total of 95 patients (100 hips) who underwent PAO with post-operative administration of fondaparinux for thromboprophylaxis were retrospectively enrolled. The incidences of DVT on ultrasound, major bleeding, and administration cessation were evaluated. Asymptomatic DVT occurred in one patient, major bleeding occurred in 14 hips and the administration of fondaparinux was stopped in 17 hips. Given the observed incidence of major bleeding, safer DVT prophylaxis modalities should be considered during PAO.

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          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.

          VTE is a serious, but decreasing complication following major orthopedic surgery. This guideline focuses on optimal prophylaxis to reduce postoperative pulmonary embolism and DVT. The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. In patients undergoing major orthopedic surgery, we recommend the use of one of the following rather than no antithrombotic prophylaxis: low-molecular-weight heparin; fondaparinux; dabigatran, apixaban, rivaroxaban (total hip arthroplasty or total knee arthroplasty but not hip fracture surgery); low-dose unfractionated heparin; adjusted-dose vitamin K antagonist; aspirin (all Grade 1B); or an intermittent pneumatic compression device (IPCD) (Grade 1C) for a minimum of 10 to 14 days. We suggest the use of low-molecular-weight heparin in preference to the other agents we have recommended as alternatives (Grade 2C/2B), and in patients receiving pharmacologic prophylaxis, we suggest adding an IPCD during the hospital stay (Grade 2C). We suggest extending thromboprophylaxis for up to 35 days (Grade 2B). In patients at increased bleeding risk, we suggest an IPCD or no prophylaxis (Grade 2C). In patients who decline injections, we recommend using apixaban or dabigatran (all Grade 1B). We suggest against using inferior vena cava filter placement for primary prevention in patients with contraindications to both pharmacologic and mechanical thromboprophylaxis (Grade 2C). We recommend against Doppler (or duplex) ultrasonography screening before hospital discharge (Grade 1B). For patients with isolated lower-extremity injuries requiring leg immobilization, we suggest no thromboprophylaxis (Grade 2B). For patients undergoing knee arthroscopy without a history of VTE, we suggest no thromboprophylaxis (Grade 2B). Optimal strategies for thromboprophylaxis after major orthopedic surgery include pharmacologic and mechanical approaches.
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            The epidemiology of venous thromboembolism

            Venous thromboembolism (VTE) is categorized by the U.S. Surgeon General as a major public health problem. VTE is relatively common and associated with reduced survival and substantial health-care costs, and recurs frequently. VTE is a complex (multifactorial) disease, involving interactions between acquired or inherited predispositions to thrombosis and VTE risk factors, including increasing patient age and obesity, hospitalization for surgery or acute illness, nursing-home confinement, active cancer, trauma or fracture, immobility or leg paresis, superficial vein thrombosis, and, in women, pregnancy and puerperium, oral contraception, and hormone therapy. Although independent VTE risk factors and predictors of VTE recurrence have been identified, and effective primary and secondary prophylaxis is available, the occurrence of VTE seems to be relatively constant, or even increasing.
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              Periacetabular osteotomy: a systematic literature review.

              The Bernese periacetabular osteotomy is commonly used to treat symptomatic acetabular dysplasia. Although periacetabular osteotomy is becoming a more common surgical intervention to relieve pain and improve function, the strength of clinical evidence to support this procedure for these goals is not well defined in the literature. We therefore performed a systematic review of the literature to define the level of evidence for periacetabular osteotomy, to determine deformity correction, clinical results, and to determine complications associated with the procedure. Thirteen studies met our inclusion criteria. Eleven studies were Level IV, one was Level III, and one was Level II. Radiographic deformity correction was consistent and improvement in hip function was noted in all studies. Most studies did not correlate radiographic and clinic outcomes. Clinical failures were commonly associated with moderate to severe preoperative osteoarthritis and conversion to THA was reported in 0% to 17% of cases. Major complications were noted in 6% to 37% of the procedures. These data indicate periacetabular osteotomy provides pain relief and improved hip function in most patients over short- to midterm followup. The current evidence is primarily Level IV. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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                Author and article information

                Contributors
                Journal
                J Hip Preserv Surg
                J Hip Preserv Surg
                jhps
                Journal of Hip Preservation Surgery
                Oxford University Press (UK )
                2054-8397
                August 2021
                17 August 2021
                17 August 2021
                : 8
                : 3
                : 293-297
                Affiliations
                departmentDepartment of Orthopaedic Surgery, Kitasato University School of Medicine , 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
                departmentDepartment of Orthopaedic Surgery, Kitasato University School of Medicine , 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
                departmentDepartment of Orthopaedic Surgery, Kitasato University School of Medicine , 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
                departmentDepartment of Orthopaedic Surgery, Kitasato University School of Medicine , 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
                departmentDepartment of Patient Safety and Healthcare Administration, Kitasato University School of Medicine , 1-15-1 Kitasato, Sagamihara 252-0374, Japan
                departmentDepartment of Rehabilitation, Kitasato University School of Allied Health Sciences , 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0329, Japan
                departmentDepartment of Orthopaedic Surgery, Kitasato University School of Medicine , 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Japan
                Author notes
                *Correspondence to: K. Fukushima. E-mail: kenfu@ 123456r4.dion.ne.jp
                Author information
                https://orcid.org/0000-0001-8599-0872
                Article
                hnab066
                10.1093/jhps/hnab066
                8994105
                35414948
                ce049d4c-badc-46ab-b893-c5e580bb9a46
                © The Author(s) 2021. Published by Oxford University Press.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 05 January 2021
                : 12 May 2021
                : 23 July 2021
                : 18 July 2021
                : 17 August 2021
                Page count
                Pages: 5
                Categories
                Research Article
                AcademicSubjects/MED00960

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