Division of Hematology, University of Toronto, Toronto, Canada.
Thromb Res. 2012 Aug;130(2):166-72. doi: 10.1016/j.thromres.2012.01.013. Epub 2012 Feb 23.
The American College of Chest Physicians (ACCP) guidelines recommends thromboprophylaxis for total hip replacement (THR) and total knee replacement (TKR) patients. We examined alignment with ACCP thromboprophylaxis guidelines among THR/TKR patients, and compared symptomatic venous thromboembolism (VTE), bleeding event rates and risk factors for VTE between patients receiving ACCP-recommended thromboprophylaxis ('ACCP') and those who did not ('non-ACCP').
This retrospective observational study used a large US health plan claims database that was linked to an inpatient database containing detailed inpatient medication use and a database containing date-of-death information. Patients who had THR/TKR surgery between April 01, 2004 and December 31, 2006 were included. Comparisons of VTE and bleeding events between ACCP and non-ACCP patients were analyzed using chi-squared tests and multivariate logistic regression.
Of 3,497 linked patients, 1,395 (40%) received ACCP recommended thromboprophylaxis. Of the patients who received non-ACCP recommended prophylaxis the majority (81%) received shorter than the recommended minimum 10 day prophylaxis and 118 (5.6%) of patients received no prophylaxis. Overall, non-ACCP patients were almost twice as likely to experience an incident DVT (3.76% versus 2.01%, p=0.003) and more than eight times as likely to experience an incident PE (1.19% versus 0.14%, p=0.001) relative to ACCP patients; there were no statistically significant difference in bleeding rates. Multivariate logistic regression indicated that the odds of a VTE event were significantly lower for ACCP patients (DVT: OR=0.54; p=0.006; PE: OR=0.12; p=0.004).
This study offers a unique perspective on 'real-world' thromboprophylaxis patterns and associated outcomes in THR and TKR patients in the US. It suggests that only 40% of THR/TKR patients receive ACCP-recommended thromboprophylaxis and that not receiving ACCP thromboprophylaxis is an independent risk factor for both DVT and PE.
美国胸科医师学会（ACCP）指南建议对全髋关节置换术（THR）和全膝关节置换术（TKR）患者进行血栓预防。我们检查了 THR/TKR 患者与 ACCP 血栓预防指南的一致性，并比较了接受 ACCP 推荐的血栓预防（“ACCP”）和未接受的患者（“非 ACCP”）之间的症状性静脉血栓栓塞症（VTE）、出血事件发生率和 VTE 的风险因素。
本回顾性观察性研究使用了一个大型美国健康计划索赔数据库，该数据库与一个包含详细住院药物使用信息的住院数据库以及一个包含死亡日期信息的数据库相关联。纳入 2004 年 4 月 1 日至 2006 年 12 月 31 日期间进行 THR/TKR 手术的患者。使用卡方检验和多变量逻辑回归分析 ACCP 和非 ACCP 患者之间的 VTE 和出血事件比较。
在 3497 名关联患者中，有 1395 名（40%）接受了 ACCP 推荐的血栓预防。在接受非 ACCP 推荐预防的患者中，大多数（81%）接受的预防时间短于推荐的最短 10 天，118 名（5.6%）患者未接受预防。总体而言，非 ACCP 患者发生事件性 DVT 的可能性几乎是 ACCP 患者的两倍（3.76%比 2.01%，p=0.003），发生事件性 PE 的可能性超过八倍（1.19%比 0.14%，p=0.001）；出血率无统计学差异。多变量逻辑回归表明，ACCP 患者发生 VTE 事件的可能性显著降低（DVT：OR=0.54；p=0.006；PE：OR=0.12；p=0.004）。
本研究提供了美国 THR 和 TKR 患者“真实世界”血栓预防模式和相关结局的独特视角。它表明，只有 40%的 THR/TKR 患者接受了 ACCP 推荐的血栓预防，而不接受 ACCP 血栓预防是 DVT 和 PE 的独立危险因素。
