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Review
. 2013 May;471(5):1523-32.
doi: 10.1007/s11999-012-2758-9.

The incidence of pulmonary embolism and deep vein thrombosis after knee arthroplasty in Asians remains low: a meta-analysis

Woo-Suk Lee  1 , Kang-Il Kim, Han-Jun Lee, Hee-Soo Kyung, Seung-Suk Seo
Affiliations
Review

The incidence of pulmonary embolism and deep vein thrombosis after knee arthroplasty in Asians remains low: a meta-analysis

Woo-Suk Lee et al. Clin Orthop Relat Res. 2013 May.

Abstract

Background: While Western literature has mostly reported the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) after TKA with chemoprophylaxis, the Asian literature still has mostly reported the incidence without chemoprophylaxis. This may reflect a low incidence of DVT and PE in Asian patients, although some recent studies suggest the incidence after TKA in Asian patients is increasing. Moreover, it is unclear whether the incidence of DVT and PE after TKA is similarly low among different Asian countries.

Questions/purposes: We therefore determined the overall incidence of symptomatic PE and DVT without chemoprophylaxis after TKA in the Asian population, determined whether the incidence had a tendency to increase over time in Asia, and compared the incidence of symptomatic PE and DVT among Asian countries through a meta-analysis.

Methods: We searched the PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar websites for prospective studies published between 1996 and 2011. A total of 1947 patients from 18 studies were reviewed for meta-analysis.

Results: The incidence of symptomatic PE was 0.01%. The incidences of overall DVT, proximal DVT, and symptomatic DVT were 40.4%, 5.8% and 1.9%, respectively. We found no difference in incidence of symptomatic PE among Asian countries and no trends in changes of the incidence over time.

Conclusions: The incidence of symptomatic PE and DVT after TKA without prophylaxis is low in Asian countries and has not changed over time, despite Westernizing lifestyles and an aging populace. Further investigation with large randomized studies is necessary to confirm our findings and identify risk factors predisposing to DVT.

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Figures

Fig. 1
Fig. 1
A flowchart shows the selection process of studies.
Fig. 2
Fig. 2
The forest plot shows rates of symptomatic PE with a table of summarized data in Asian countries. The incidence of symptomatic PE was extremely low (0.01%; 95% CI, 0.00–0.07).
Fig. 3
Fig. 3
The forest plot shows rates of overall DVT with a table of summarized data in Asian countries. The incidence of overall DVT after TKA was 40.4% (95% CI, 28.5–52.3).
Fig. 4
Fig. 4
The forest plot shows rates of proximal DVT with a table of summarized data in Asian countries. The incidence of proximal DVT after TKA was 5.8% (95% CI, 3.7–7.9).
Fig. 5
Fig. 5
The forest plot shows rates of distal DVT with a table of summarized data in Asian countries. The incidence of distal DVT after TKA was 26.6% (95% CI, 23.9–29.6).
Fig. 6
Fig. 6
The forest plot shows rates of symptomatic DVT with a table of summarized data in Asian countries. The incidence of symptomatic DVT after TKA was 1.9% (95% CI, 0.6–3.1).
Fig. 7
Fig. 7
A graph shows the incidences of symptomatic PE and proximal DVT stratified by midyear of study. The incidences of symptomatic PE and proximal DVT did not increase over time in Asian patients.
Fig. 8
Fig. 8
A graph shows the reported incidences of symptomatic PE, proximal DVT, and overall DVT per country. The incidences of overall and proximal DVT were different among Asian countries, but the incidences of symptomatic PE were similarly low.
See this image and copyright information in PMC

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