Gill Sukhdeep K, Theodorides Antony, Smith Nicola, Maguire Esther, Whitehouse Sarah L, Rigby Michael C, Ivory John P
Trauma and Orthopaedic Department, Great Western Hospital, Swindon, Wiltshire, UK.
Hip Int. 2011 Nov-Dec;21(6):678-83. doi: 10.5301/HIP.2011.8842.
In the United Kingdom, national guidelines have stated that patients undergoing elective hip surgery are at increased risk for venous thromboembolic events (VTE) following surgery and have recommended thromboprophylaxis for 28-35 days (1, 2). Studies of direct thrombin inhibitors have hitherto concentrated on major bleeding. We prospectively assessed wound discharge in patients who underwent hip arthroplasty and who received oral dabigatran postoperatively between March 2010 and April 2010 (n=56). We compared these results to a retrospective matched group of patients who underwent similar operations six months earlier, at which time all patients were given subcutaneous dalteparin routinely postoperatively until discharge, and then discharged home on 150 mg aspirin daily for 6 weeks (n=67). Wound discharge after 5 days was significantly higher in the patients taking dabigatran (32% dabigatran n=18, 10% dalteparin n=17, p=0.003) and our rate of delayed discharges due to wound discharge significantly increased from 7% in the dalteparin group (n=5) to 27% for dabigatran (n=15, p=0.004). Patients who received dabigatran were more than five times as likely to return to theatre with a wound complication compared with those who received dalteparin (7% dabigatran n=4, vs. 1% dalteparin n=1), but this was not statistically significant (p=0.18). We now administer dalteparin until the wound is dry and then start dabigatran. Our study demonstrates the need for further clinical studies regarding wound discharge and direct thrombin inhibitors.
在英国，国家指南指出，接受择期髋关节手术的患者术后发生静脉血栓栓塞事件（VTE）的风险增加，并建议进行28 - 35天的血栓预防（1, 2）。迄今为止，直接凝血酶抑制剂的研究主要集中在大出血方面。我们前瞻性评估了2010年3月至2010年4月期间接受髋关节置换术且术后接受口服达比加群治疗的患者（n = 56）的伤口引流情况。我们将这些结果与一组6个月前进行类似手术的回顾性匹配患者进行了比较，当时所有患者术后常规接受皮下注射达肝素直至出院，然后出院回家每日服用150 mg阿司匹林，共6周（n = 67）。服用达比加群的患者术后5天的伤口引流明显更高（达比加群组32%，n = 18；达肝素组10%，n = 17，p = 0.003），并且因伤口引流导致的延迟出院率从达肝素组的7%（n = 5）显著增加到达比加群组的27%（n = 15，p = 0.004）。与接受达肝素的患者相比，接受达比加群的患者因伤口并发症返回手术室的可能性高出五倍多（达比加群组7%，n = 4；达肝素组1%，n = 1），但这在统计学上无显著差异（p = 0.18）。我们现在先给予达肝素直至伤口干燥，然后开始使用达比加群。我们的研究表明需要针对伤口引流和直接凝血酶抑制剂进行进一步的临床研究。
