Characteristics, treatment patterns and outcomes of patients presenting with venous thromboembolic events after knee arthroscopy in the RIETE Registry
Knee arthroscopy is the most common orthopedic procedure worldwide. While incidence of post-arthroscopy venous thromboembolic events (VTE) is low, treatment patterns and patient outcomes have not been described. Patients from the “Registro Informatizado Enfermedad TromboEmbolica” who had confirmed post-arthroscopy VTE were compared to patients with provoked, post bone-fracture, and to patients with unprovoked VTE. Baseline characteristics, presenting signs and symptoms, treatment and outcomes including recurrent VTE, bleeds or death were compared. A total of 101 patients with post-arthroscopy VTE and 19,218 patients with unprovoked VTE were identified. Post-arthroscopy patients were younger (49.5 vs. 66 years, P < 0.0001) and had less history of VTE [5.9% vs. 20%, OR 0.26 (0.11–0.59)]. Among patients with isolated DVT, there were fewer proximal DVT in the post-arthroscopy group [40% vs. 86%, OR 0.11 (0.06–0.19)]. Treatment duration was shorter in the post-arthroscopy group (174 ± 140 vs. 311 ± 340 days, P < 0.0001) and more often with DOAC [OR 3.67 (1.95–6.89)]. Recurrent VTE occurred in 6.18 (1.96–14.9) and 11.9 (11.0–12.8) per 100 patient years [HR 0.52 (0.16–1.26)] after treatment in the post-arthroscopy and unprovoked groups, respectively. Recurrent VTE occurred in 5.17 (1.31–14.1) per 100 patient years in a separate post bone-fracture group (n = 147), also not statistically different than the post-arthroscopy recurrence rate. After anticoagulation cessation, some patients post-knee arthroscopy develop VTE. While our small sample size precludes drawing firm conclusions, this signal should warrant further research into the optimal treatment duration for these patients, as some patients may be at increased risk for long-term recurrence.
KeywordsVenous thromboembolism Arthroscopy Anticoagulation Knee arthroscopy Deep vein thrombosis Pulmonary embolism
We express our gratitude to Sanofi Spain for supporting this Registry with an unrestricted educational grant. We also express our gratitude to Bayer Pharma AG for supporting this Registry. Bayer Pharma AG’s support was limited to the part of RIETE outside Spain, which accounts for a 25.02% of the total patients included in the RIETE Registry. We also thank the RIETE Registry Coordinating Center, S&H Medical Science Service, for their quality control data, logistic and administrative support and Prof. Salvador Ortiz, Universidad Autónoma Madrid and Silvia Galindo, both Statistical Advisors in S&H Medical Science Service for the statistical analysis of the data presented in this paper.
Coordinator of the RIETE Registry: Dr. Manuel Monreal (Spain). RIETE Steering Committee Members: Dr. Paolo Prandoni (Italy), Dr. Benjamin Brenner (Israel), Dr. Dominique Farge-Bancel (France). RIETE National Coordinators: Dr. Raquel Barba (Spain), Dr. Pierpaolo Di Micco (Italy), Dr. Laurent Bertoletti (France), Dr. Inna Tzoran (Israel), Dr. Abilio Reis (Portugal), Dr. Henri Bounameaux (Switzerland), Dr. Radovan Malý (Czech Republic), Dr. Peter Verhamme (Belgium), Dr. Marijan Bosevski (Republic of Macedonia), Dr. Joseph A. Caprini (USA), Dr. Hanh My Bui (Vietnam). RIETE Registry Coordinating Center: S & H Medical Science Service. Members of the RIETE Group: Spain: Adarraga MD, Agudo P, Aibar MA, Aibar J, Amado C, Akasbi M, Aranda C, Arcelus JI, Arenas A, Ballaz A, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Blanco-Molina A, Camon AM, Carrasco C, Castro J, Cruz AJ, de Ancos C, del Toro J, Demelo P, Díaz-Pedroche MC, Díaz-Peromingo JA, Falgá C, Farfán AI, Fernández-Capitán C, Fidalgo MA, Font C, Font L, García MA, García-Bragado F, García-Morillo M, García-Raso A, Gavín O, Gayol MC, Gil-Díaz A, Gómez V, González-Martínez J, Grau E, Gutiérrez J, Hernández-Blasco L, Iglesias M, Jara-Palomares L, Jaras MJ, Jiménez D, Jou I, Joya MD, Lalueza A, Lima J, Llamas P, Lobo JL, López-Jiménez L, López-Miguel P, López-Nuñez JJ, López-Reyes R, López-Sáez JB, Lorente MA, Lorenzo A, Loring M, Loscos S, Lumbierres M, Marchena PJ, Martín-Fernández M, Martín-Guerra JM, Martín-Romero M, Mellado M, Modesto M, Monreal M, Morales MV, Nieto JA, Núñez A, Núñez MJ, Olivares MC, Otalora S, Otero R, Pedrajas JM, Pellejero G, Pérez-Jacoiste A, Pérez-Rus G, Peris ML, Pesce ML, Porras JA, Rivas A, Rodríguez-Dávila MA, Rodríguez-Fernández L, Rodríguez-Hernández A, Rosa V, Rosillo-Hernández EM, Rubio CM, Ruiz-Alcaraz S, Ruiz-Artacho P, Ruiz-Ruiz J, Ruiz-Sada P, Sahuquillo JC, Sampériz A, Sánchez-Muñoz-Torrero JF, Sancho T, Sanoja ID, Soler S, Soto MJ, Suriñach JM, Tapia E, Torres MI, Trujillo-Santos J, Uresandi F, Usandizaga E, Valle R, Vela JR, Vilar C, Argentina: Gutiérrez P, Vázquez FJ, Vilaseca A, Belgium: Vanassche T, Vandenbriele C, Verhamme P, Brazil: Yoo HHB, Czech Republic: Hirmerova J, Malý R, Ecuador: Salgado E, France: Benzidia I, Bertoletti L, Bura-Riviere A, Debourdeau P, Falvo N, Farge-Bancel D, Hij A, Mahé I, Moustafa F, Israel: Braester A, Brenner B, Ellis M, Tzoran I, Italy: Barillari G, Bilora F, Bortoluzzi C, Brandolin B, Bucherini E, Camerota A, Ciammaichella M, Dentali F, Di Micco P, Grandone E, Imbalzano E, Lessiani G, Maida R, Mastroiacovo D, Ngoc V, Pace F, Parisi R, Pesavento R, Pinelli M, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Sotgiu P, Tufano A, Visonà A, LATVIA: Gibietis V, Skride A, Strautmane S, Republic of Macedonia: Bosevski M, Zdraveska M, Switzerland: Bounameaux H, Mazzolai L, USA: Caprini J, Vietnam: Bui HM.
This study was funded by Sanofi Spain with an unrestricted educational grant and Bayer Pharma AG. Bayer Pharma AG’s support was limited to the part of RIETE outside Spain, which accounts for a 25.02% of the total patients included in the RIETE Registry.
Compliance with ethical standards
Conflict of interest
Ido Weinberg serves on the Scientific Advisory Board, Novate Medical. Jay Giri serves on the Board of Directors for PERT Consortium, a 501c3 not-for-profit organization. Raghu Kolluri serves on the Board of Directors for VIVA Physicians Inc, a 501c3 not-for-profit organization. He is a paid consultant or serves on the Advisory Board for Medtronic, Philips/Volcano, BTG, Janssen, Vesper Medical, Innovein, Spectranetics, Inari, Boston Scientific. He has received research support from BTG. Juan Ignacio Arcelus, Conxita Falgá, Silvia Soler, Andrei Braester, José Bascuñana, Javier Gutiérrez-Guisado and Manuel Monreal declares no conflicts of interests.
Participating centers have local Institutional Review Board approval with patients providing informed consent for registry enrollment.
- 18.Camporese G, Bernardi E, Prandoni P, Noventa F, Verlato F, Simioni P, Ntita K, Salmistraro G, Frangos C, Rossi F, Cordova R, Franz F, Zucchetta P, Kontothanassis D, Andreozzi GM, Group KS (2008) Low-molecular-weight heparin versus compression stockings for thromboprophylaxis after knee arthroscopy: a randomized trial. Ann Intern Med 149:73–82CrossRefPubMedGoogle Scholar
- 19.Camporese G, Bernardi E, Noventa F, Bosco M, Monteleone G, Santoro L, Bortoluzzi C, Freguja S, Nardin M, Marullo M, Zanon G, Mazzola C, Damiani G, Maniscalco P, Imberti D, Lodigiani C, Becattini C, Tonello C, Agnelli G, Group ES (2016) Efficacy of rivaroxaban for thromboprophylaxis after knee arthroscopy (ERIKA). A phase II, multicentre, double-blind, placebo-controlled randomised study. Thromb Haemost 116:349–355CrossRefPubMedGoogle Scholar
- 24.Bikdeli B, Jimenez D, Hawkins M, Ortiz S, Prandoni P, Brenner B, Decousus H, Masoudi FA, Trujillo-Santos J, Krumholz HM, Monreal M, Investigators R, Rationale (2018) Design and methodology of the computerized registry of patients with venous thromboembolism (RIETE). Thromb Haemost 118:214–224CrossRefPubMedGoogle Scholar
- 25.Schulman S, Kearon C, Subcommittee on Control of Anticoagulation of the S, Standardization Committee of the International Society on T and Haemostasis (2005) Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost 3:692–694CrossRefPubMedGoogle Scholar