Hitos K, Fletcher J P
Department of Surgery, University of Sydney, Westmead Hospital, Westmead, NSW, Australia.
Int Angiol. 2009 Jun;28(3):215-21.
In the absence of thromboprophylaxis, venographically detected deep vein thrombosis (DVT) occurs in approximately 50% of patients undergoing primary total hip arthroplasty. Despite the existence of national and international guidelines, thromboprophylaxis may be underused.
A retrospective review was performed of the clinical incidence of venous thromboembolism (VTE) and thromboprophylactic practice patterns over a nine year period. Patient baseline characteristics, VTE risk factors, prophylactic modalities (mechanical and pharmacological), operation duration, type of prosthesis and fixation, mode of anesthesia, hospital length of stay (LOS) were analyzed. The main efficacy outcome was DVT and/or pulmonary embolism (PE). The primary safety outcome was major bleeding.
In-hospital incidence of VTE was 2.5% and 3.8% up to three months post hospital discharge. Median time to postoperative VTE development in-hospital and after discharge was 6.5 days (IQR: 5.0 to 8.0 days) and 29.0 days (IQR: 19.5 to 38.0 days) respectively. 66.7% (95% CI: 30.0 to 90.3%) of all readmissions for VTE occurred within one month post-operatively. There were no readmissions for VTE in patients discharged on extended pharmacological prophylaxis.
The use of prophylactic protocols was associated with relatively low VTE rates up to three months with minimal bleeding complications. A more intense in-hospital and extended prophylaxis beyond hospitalization is recommended in this high risk group of patients.
在未进行血栓预防的情况下，经静脉造影检测发现，初次全髋关节置换术患者中约50%会发生深静脉血栓形成（DVT）。尽管有国家和国际指南，但血栓预防措施可能未得到充分应用。
对9年期间静脉血栓栓塞症（VTE）的临床发病率和血栓预防实践模式进行回顾性研究。分析患者的基线特征、VTE危险因素、预防方式（机械性和药物性）、手术时长、假体类型及固定方式、麻醉方式、住院时间（LOS）。主要疗效指标为DVT和/或肺栓塞（PE）。主要安全性指标为大出血。
住院期间VTE的发生率为2.5%，出院后3个月内为3.8%。住院期间和出院后发生术后VTE的中位时间分别为6.5天（四分位间距：5.0至8.0天）和29.0天（四分位间距：19.5至38.0天）。所有因VTE再次入院的患者中，66.7%（95%置信区间：30.0至90.3%）发生在术后1个月内。接受延长药物预防治疗出院的患者中没有因VTE再次入院的情况。
在长达3个月的时间里，使用预防方案与相对较低的VTE发生率及最少的出血并发症相关。建议对这类高危患者在住院期间进行更强化的预防，并在出院后延长预防时间。
