Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200 Aarhus N, Denmark.
J Bone Joint Surg Am. 2010 Sep 15;92(12):2156-64. doi: 10.2106/JBJS.I.00882.
Data on the risk factors for venous thromboembolism among patients undergoing total hip replacement and receiving pharmacological thromboprophylaxis are limited. The purpose of this study was to examine potential patient-related risk factors for venous thromboembolism following total hip replacement in a nationwide follow-up study.
Using medical databases, we identified all patients who underwent primary total hip replacement and received pharmacological thromboprophylaxis in Denmark from 1995 to 2006. The outcome measure was hospitalization with venous thromboembolism within ninety days of surgery. We considered age, sex, indication for primary total hip replacement, calendar year of surgery, and comorbidity history as potential risk factors.
The overall rate of hospitalization for venous thromboembolism within ninety days following a primary total hip replacement was 1.02% (686 hospitalizations after 67,469 procedures) at a median of twenty-two days. The incidence of symptomatic deep venous thrombosis and of nonfatal pulmonary embolism was 0.7% (499 of 67,469) and 0.3% (205 of 67,469), respectively. The incidence of death due to venous thromboembolism or from all causes was 0.05% (thirty-eight patients) and 1.0% (678 patients), respectively. Patients with rheumatoid arthritis had a reduced relative risk for venous thromboembolism compared with patients with primary osteoarthritis (adjusted relative risk = 0.47; 95% confidence interval, 0.25 to 0.90). Patients with a high score on the Charlson comorbidity index had an increased relative risk for venous thromboembolism compared with patients with a low score (adjusted relative risk = 1.45; 95% confidence interval, 1.02 to 2.05). Patients with a history of cardiovascular disease (relative risk = 1.40; 95% confidence interval, 1.15 to 1.70) or prior venous thromboembolism (relative risk = 8.09; 95% confidence interval, 6.07 to 10.77) had an increased risk for venous thromboembolism compared with patients without that history.
The cumulative incidence of a venous thromboembolism within ninety days of surgery among patients with total hip replacement receiving pharmacological thromboprophylaxis was 1%. This information on the associated risk factors could be used to better anticipate the risk of venous thromboembolism for an individual patient.
接受全髋关节置换术并接受药物血栓预防的患者静脉血栓栓塞风险因素的数据有限。本研究的目的是在全国性随访研究中检查全髋关节置换术后患者静脉血栓栓塞的潜在患者相关风险因素。
使用医疗数据库，我们确定了 1995 年至 2006 年期间在丹麦接受初次全髋关节置换术和药物血栓预防的所有患者。结局指标为术后 90 天内因静脉血栓栓塞住院。我们认为年龄、性别、初次全髋关节置换术的适应证、手术年份和合并症病史是潜在的危险因素。
初次全髋关节置换术后 90 天内因静脉血栓栓塞住院的总体发生率为 1.02%（67469 例手术中有 686 例住院），中位数为 22 天。有症状的深部静脉血栓形成和非致命性肺栓塞的发生率分别为 0.7%（67469 例中有 499 例）和 0.3%（67469 例中有 205 例）。静脉血栓栓塞或因任何原因导致的死亡发生率分别为 0.05%（38 例）和 1.0%（678 例）。类风湿关节炎患者发生静脉血栓栓塞的相对风险低于原发性骨关节炎患者（调整后相对风险=0.47；95%置信区间，0.25 至 0.90）。Charlson 合并症指数评分较高的患者发生静脉血栓栓塞的相对风险高于评分较低的患者（调整后相对风险=1.45；95%置信区间，1.02 至 2.05）。有心血管疾病病史（相对风险=1.40；95%置信区间，1.15 至 1.70）或既往静脉血栓栓塞病史（相对风险=8.09；95%置信区间，6.07 至 10.77）的患者发生静脉血栓栓塞的风险高于无该病史的患者。
接受药物血栓预防的全髋关节置换术患者术后 90 天内静脉血栓栓塞的累积发生率为 1%。这些与风险因素相关的信息可用于更好地预测个体患者静脉血栓栓塞的风险。
