Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
Clin Orthop Relat Res. 2010 Jan;468(1):115-9. doi: 10.1007/s11999-009-1020-6. Epub 2009 Aug 11.
Pulmonary embolism (PE) complicates 1% to 10% of total joint arthroplasties and generally requires immediate anticoagulation. Low-molecular-weight heparins have supplanted unfractionated heparin as the treatment of choice for PE and hold a 1A recommendation from the American College of Chest Physicians for this indication. However, the complications of enoxaparin treatment begun in close proximity to arthroplasty surgery are not well described. We examined the records of 135 patients who underwent total joint arthroplasty, experienced an in-hospital PE, and received treatment with enoxaparin at therapeutic doses (1 mg/kg body weight). The type and frequency of complications were determined and classified as major or minor. Twenty-seven percent of patients experienced minor complications and 10% experienced major complications. The incidence of major bleeding was substantially higher than rates reported for nonsurgical patients. The overall complication rate of enoxaparin treatment is similar to the rate of complications reported for unfractionated heparin treatment in this setting, but the complications are less severe.
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
肺栓塞（PE）在全关节置换术中的发生率为 1%至 10%，通常需要立即抗凝治疗。低分子肝素已取代普通肝素成为 PE 的首选治疗药物，美国胸科医师学会（ACCP）为此适应证推荐 1A 类证据。然而，接近关节置换手术时开始使用依诺肝素治疗的并发症尚未得到很好的描述。我们检查了 135 例接受全关节置换术、发生院内 PE 并接受依诺肝素（1mg/kg 体重）治疗的患者的记录。确定了并发症的类型和频率，并分为主要或次要。27%的患者出现轻微并发症，10%的患者出现严重并发症。大出血的发生率明显高于非手术患者的报告率。依诺肝素治疗的总体并发症发生率与该治疗环境下普通肝素治疗的并发症发生率相似，但并发症的严重程度较低。
IV 级，治疗性研究。有关证据水平的完整描述，请参见作者指南。
