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Stress-induced hyperglycaemia and venous thromboembolism following total hip or total knee arthroplasty: analysis from the RECORD trials.
Stress-induced hyperglycaemia and venous thromboembolism following total hip or total knee arthroplasty: analysis from the RECORD trials.
- Source :
-
Thrombosis and haemostasis [Thromb Haemost] 2012 Feb; Vol. 107 (2), pp. 225-31. Date of Electronic Publication: 2011 Dec 21. - Publication Year :
- 2012
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Abstract
- Stress-induced hyperglycaemia is common during orthopaedic surgery. In addition, hyperglycaemia activates coagulation. The aim of the study was to assess whether stress-induced hyperglycaemia is associated with symptomatic or asymptomatic venous thromboembolism (VTE) following orthopaedic surgery. We performed post-hoc analyses in the four RECORD studies (REgulation of Coagulation in major Orthopaedic surgery reducing the Risk of Deep venous thrombosis and pulmonary embolism). Separate analyses were performed for patients undergoing elective total hip or knee replacement. Outcome measures were symptomatic VTE and "total VTE" (defined as the composite of symptomatic VTE, asymptomatic DVT assessed by per protocol venography and all cause mortality). Glucose levels were measured pre-op and 6 hours post-op, categorised into quartiles, based on the distribution in the respective cohorts. The influence of glucose, adjusted for body mass index, age, gender and diabetes mellitus on VTE was assessed by logistic regression analyses. A total of 12,383 patients were eligible for assessment of symptomatic VTE, and 8,512 patients were eligible for assessment of total VTE. Increased glucose levels after total hip replacement were associated with total VTE; adjusted odds ratio (OR) highest versus lowest quartile 1.9 (95% confidence interval [CI] 1.3 to 3.0). Furthermore, increase in glucose levels during total hip replacement was associated with total VTE (OR highest versus lowest quartile 1.8 (95%CI 1.2 to 2.8). This was not observed in patients undergoing total knee replacement, probably due to differences in the applied surgical procedures.
- Subjects :
- Aged
Clinical Trials, Phase III as Topic
Cohort Studies
Female
Glucose metabolism
Humans
Hyperglycemia epidemiology
Hyperglycemia mortality
Hyperglycemia physiopathology
Male
Middle Aged
Multicenter Studies as Topic
Phlebography
Postoperative Complications epidemiology
Postoperative Complications mortality
Postoperative Complications physiopathology
Survival Analysis
Venous Thromboembolism epidemiology
Venous Thromboembolism mortality
Venous Thromboembolism physiopathology
Arthroplasty, Replacement, Hip adverse effects
Arthroplasty, Replacement, Knee adverse effects
Hyperglycemia etiology
Postoperative Complications etiology
Stress, Psychological complications
Venous Thromboembolism etiology
Subjects
Details
- Language :
- English
- ISSN :
- 2567-689X
- Volume :
- 107
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Thrombosis and haemostasis
- Publication Type :
- Academic Journal
- Accession number :
- 22187097
- Full Text :
- https://doi.org/10.1160/TH11-07-0447