Kimura Kazumasa, Ohtani Shigeki, Okamura Hiroshi, Ishii Nobukazu, Kishimoto Chieko, Konishi Kunihiko
Department of Orthopaedic Surgery, Kyohritsu General Hospital, Nagoya, Japan.
Clin Appl Thromb Hemost. 2009 Feb;15(1):109-12. doi: 10.1177/1076029607304724.
The authors evaluated the prophylactic protocols with unfractionated heparin (UFH) and warfarin in Japanese patients who underwent total knee arthroplasty (TKA) for osteoarthritis knee in regard to bleeding complications. Fifty-six patients who underwent TKA for osteoarthritis knee with the use of methylmethacrylate were included. Subcutaneous UFH and warfarin were administered for thromboprophylaxis to the first group of 26 patients. The second group of 30 patients did not receive any pharmacological thromboprophylaxis and were used as controls. No significant differences were found between the 2 groups for operative and postoperative blood loss. There were no cases with major bleeding as a complication, but for 2 cases, the international normalized ratio high value exceeded the remedy limits, and temporary dosage discontinuance was required. There were no clinically important bleeding events in the 2 groups. No heparin-induced thrombocytopenia or warfarin-induced skin necrosis occurred. The authors conclude that the protocol with UFH and warfarin is safe for thromboprophylaxis against deep venous thrombosis and pulmonary embolism after TKA in Japanese patients, but its efficacy can only be resolved with further studies.
作者针对出血并发症，评估了普通肝素（UFH）和华法林在因膝骨关节炎接受全膝关节置换术（TKA）的日本患者中的预防方案。纳入了56例使用甲基丙烯酸甲酯因膝骨关节炎接受TKA的患者。对第一组26例患者皮下注射UFH和华法林进行血栓预防。第二组30例患者未接受任何药物性血栓预防，作为对照组。两组在手术中和术后失血量方面未发现显著差异。没有并发症导致大出血的病例，但有2例国际标准化比值的高值超过了补救限度，需要暂时停药。两组均未发生具有临床意义的出血事件。未发生肝素诱导的血小板减少症或华法林诱导的皮肤坏死。作者得出结论，对于日本患者，UFH和华法林方案在预防TKA后深静脉血栓形成和肺栓塞方面是安全的，但其疗效只能通过进一步研究来确定。
