1. Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
2. Department of Orthopedics, Dali Bai Autonomous Prefecture People's Hospital, Dali 671000, China
3. Department of Orthopedics, Xiong'an Xuanwu Hospital, Xiong'an 071700, China
4. Department of Emergency Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| Abstract: | Objective: To investigate the effectiveness of Shengxue Busui Decoction combined with low molecular weight heparin (LMWH) in preventing deep vein thrombosis (DVT) after knee arthroplasty (KA) in elderly patients. Materials and Methods: Patients aged over 60 years who underwent KA at Xuanwu Hospital between October 2020 and June 2022 were prospectively enrolled. Participants were randomly assigned to an observation group or a control group. The control group received LMWH alone for postoperative DVT prophylaxis, while the observation group received Shengxue Busui Decoction in combination with LMWH. Routine coagulation parameters, plasma D-dimer levels, and thromboelastography (TEG) were assessed one day before surgery and three days after surgery. The occurrence of DVT was evaluated using lower limb venous ultrasound at 3 days, 1 week, and 1 month postoperatively. Pain intensity was assessed using the visual analogue scale (VAS), and knee function was evaluated using the Hospital for Special Surgery (HSS) score before surgery and at 1 week and 1 month after surgery. Bleeding events were recorded during the first postoperative month. Results: A total of 130 patients completed the study, with 65 patients in each group. There was no significant difference in baseline characteristics between the two groups. One week after surgery, the incidence of DVT was significantly lower in the observation group than in the control group (10.8% vs. 24.6%, P < 0.05). The observation group also showed a significantly lower incidence of bleeding events within one month postoperatively compared with the control group (10.8% vs. 29.2%, P < 0.05). Coagulation tests and TEG parameters indicated a relatively hypocoagulable state in the observation group compared with the control group three days after surgery. Conclusions: Shengxue Busui Decoction combined with LMWH is effective in reducing the incidence of postoperative DVT and bleeding events after KA, and may improve postoperative coagulation status. |
| Keywords: | Knee Arthroplasty; Deep Vein Thrombosis of Lower Extremity; Shengxue Busui Decoction; Thrombelastogram |
| DOI: | 10.57237/j.wjcm.2025.03.001 |
| 1. | Beijing Traditional Chinese Medicine Science and Technology Development Fund Project (JJ-2020-67) |
| 2. | Capital Fund Project for Clinical Diagnosis and Treatment Technology Research and Translational Application (Z201100005520091) |
| [1] | Lespasio MJ, Piuzzi NS, Husni ME, et al. Knee osteoarthritis: A primer. Perm J, 2017, 21: 16-183. |
| [2] | Lee SS, Seo MK, Kim IS, et al. Comparison of survival rate and outcomes between conventional and navigation-assisted primary total knee arthroplasty in severe varus knees: A minimum 10-year follow-up. J Arthroplasty, 2022, 37(11): 2164-70. |
| [3] | Ode Q, Gaillard R, Batailler C, et al. Fewer complications after UKA than TKA in patients over 85 years of age: A case-control study. Orthop Traumatol Surg Res, 2018, 104(7): 955-9. |
| [4] | Lee DK, Kim HJ, Lee DH. Incidence of deep vein thrombosis and venous thromboembolism following tka in rheumatoid arthritis versus osteoarthritis: A meta-analysis. PLoS One, 2016, 11(12): e0166844. |
| [5] | Garfinkel JH, Gladnick BP, Roland N, et al. Increased incidence of bleeding and wound complications with factor-Xa inhibitors after total joint arthroplasty. J Arthroplasty, 2018, 33(2): 533-6. |
| [6] | Jameson SS, Rymaszewska M, Hui AC, et al. Wound complications following rivaroxaban administration: a multicenter comparison with low-molecular-weight heparins for thromboprophylaxis in lower limb arthroplasty. J Bone Joint Surg Am, 2012, 94(17): 1554-8. |
| [7] | Idestrup C, Sawhney M, Nix C, et al. The incidence of hematoma formation in patients with continuous femoral catheters following total knee arthroplasty while receiving rivaroxaban as thromboprophylaxis: an observational study. Reg Anesth Pain Med, 2014, 39(5): 414-7. |
| [8] | Zhou X, Zhou Z, Jin M, et al. Intermediate and late rheumatoid arthritis treated by tonifying the kidney, resolving phlegm and removing blood stasis. J Tradit Chin Med, 2000, 20(2): 87-92. |
| [9] | Hartert H. [Blood clotting studies with Thrombus stressography; a new Investigation procedure]. Klin Wochenschr, 1948, 26(37-38): 577-83. |
| [10] | Tekkesin N, Tekkesin M, Kaso G. Thromboelastography for the monitoring of the antithrombotic effect of low-molecular-weight heparin after major orthopedic surgery. Anatol J Cardiol, 2015, 15(11): 932-7. |
| [11] | Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, 51(2): 224-32. |
| [12] | Klem NR, Smith A, O'Sullivan P, et al. What influences patient satisfaction after TKA? A qualitative investigation. Clin Orthop Relat Res, 2020, 478(8): 1850-66. |
| [13] | Oosthuizen CR, Van Der Straeten C, Maposa I, et al. The patient results and satisfaction of knee arthroplasty in a validated grading system. Int Orthop, 2019, 43(12): 2747-55. |
| [14] | Chen KJ, Chen K. Ischemic stroke treated with Ligusticum chuanxiong. Chin Med J (Engl), 1992, 105(10): 870-3. |
| [15] | Zhang Y, Liu Y, Liu Y, et al. Mechanism of Eucommiae ulmoides and Radix Dipsaci in prevention and treatment of osteoporosis:An analysis based on network pharmacology and cell experiment. Chin Pharmacol Bull, 2022, 38(9): 1401-8. |
| [16] | Li Y, Bai H, Liang X, et al. Research progress on antioxidant active components in Carthami Flos and its mechanism. Drugs Clinic, 2022, 37(8): 1879-85. |
| [17] | Yang L. The Study on the chemical composition and anti-inflammatory activity of Cyathula officinalis Kuan from Traditional Chinese Medicine [Master's Thesis]. Chengdu: Chengdu University, 2022. |
| [18] | Yang S, Anjie F, Yue S, et al. Research progress on mechanism and pharmacological activities of Total Glucosides of Paeony. Chin J Mod Appl Pharm, 2021, 38(13): 1627-33. |
| [19] | Hochleitner G, Sutor K, Levett C, et al. Revisiting Hartert's 1962 calculation of the physical constants of thrombelastography. Clin Appl Thromb Hemost, 2017, 23(3): 201-10. |
| [20] | Whiting D, DiNardo JA. TEG and ROTEM: Technology and clinical applications. Am J Hematol, 2014, 89(2): 228-32. |
| [21] | Rugeri L, Levrat A, David JS, et al. Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography. J Thromb Haemost, 2007, 5(2): 289-95. |
| [22] | Wang J, Feng X, Wang W. Effect of using Chaihuang Huoxue decoction in the prevention and treatment of deep venous thrombosis of lower extremity after hip arthroplasty. J Sichuan Trad Chin Med, 2020, 38(7): 160-3. |
| [23] | Gary JL, Schneider PS, Galpin M, et al. Can thrombelastography predict venous thromboembolic events in patients with severe extremity trauma? J Orthop Trauma, 2016, 30(6): 294-8. |
| [24] | Citak M, Klatte TO, Suero EM, et al. Are patients with preoperative air travel at higher risk for venous thromboembolism following primary total hip and knee arthroplasty? Technol Health Care, 2015, 23(3): 307-11. |
| [25] | Hughes LD, Lum J, Mahfoud Z, et al. Comparison of surgical site infection risk between Warfarin, LMWH, and aspirin for venous thromboprophylaxis in TKA or THA: A systematic review and meta-analysis. JBJS Rev, 2020, 8(12): e20.00021. |
| [26] | Kakouros N, Gluckman TJ, Conte JV, et al. Differential impact of serial measurement of nonplatelet thromboxane generation on long-term outcome after cardiac surgery. J Am Heart Assoc, 2017, 6(11): e007486. |
| [27] | Chen Y, Qin L, Yang J, et al. Changes in thromboelastography to predict ecchymosis after knee arthroplasty: A promising guide for the use of anticoagulants. Front Surg, 2022, 9: 871776. |