Hardwick Mary E, Pulido Pamela A, Colwell Clifford W
Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA.
Orthop Nurs. 2011 Sep-Oct;30(5):312-6. doi: 10.1097/NOR.0b013e31822c5c28.
Prevention of venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), has been at the forefront of orthopaedic care for many years for lower extremity arthroplasty, which is at high risk for VTE. Risk of bleeding increases in total hip arthroplasty (THA) with low-molecular-weight heparin (LMWH) prophylaxis. A mobile compression device (MCD) that allows patients to move freely in hospital and at home may be safer.
The study hypothesized that patients using MCD would have less major bleeding than patients using LMWH without affecting the efficacy of thrombosis prevention in THA.
Following THA, 395 patients at 9 healthcare sites in the United States were randomized to receive either MCD or LMWH for VTE prophylaxis.
A mobile compression device was applied in the operating room and continued for 10 days with or without aspirin 81 mg daily. Low-molecular-weight heparin was started the morning after surgery and continued for 10 days. Days 10-12 following surgery, bilateral duplex ultrasound was performed on all patients. Bleeding events were recorded during treatment and VTE events were recorded for 3 months. Number of hours of device use was recorded.
Major bleeding events occurred in 11 patients, all in the LMWH group (6%). Venous thromboembolism occurrence was similar, 5.1% in the MCD group and 5.3% in the LMWH group. The MCD group used the device 83% of possible usable time.
Findings of significantly less major bleeding in the MCD group than the LMWH group supported our hypothesis with no significant difference in VTE.
多年来，在骨科护理中，预防静脉血栓栓塞症（VTE），包括深静脉血栓形成（DVT）和肺栓塞（PE），一直是下肢关节置换术的重点，因为下肢关节置换术发生VTE的风险很高。在全髋关节置换术（THA）中，使用低分子量肝素（LMWH）进行预防会增加出血风险。一种可让患者在医院和家中自由活动的移动加压装置（MCD）可能更安全。
该研究假设，在不影响THA预防血栓形成效果的情况下，使用MCD的患者发生大出血的情况会少于使用LMWH的患者。
在美国9个医疗点进行THA手术后，395例患者被随机分配接受MCD或LMWH进行VTE预防。
在手术室应用移动加压装置，并持续使用10天，同时可每日服用或不服用81毫克阿司匹林。低分子量肝素在术后早晨开始使用，并持续10天。术后第10 - 12天，对所有患者进行双侧双功超声检查。记录治疗期间的出血事件，并记录3个月内的VTE事件。记录装置使用时长。
11例患者发生大出血事件，均在LMWH组（6%）。静脉血栓栓塞的发生率相似，MCD组为5.1%，LMWH组为5.3%。MCD组使用该装置的时间占可能使用时间的83%。
MCD组大出血明显少于LMWH组的结果支持了我们的假设，即两组在VTE方面无显著差异。
