Castillo Monsegur J, Bisbe Vives E, Santiveri Papiol X, López Bosque R, Ruiz A
Servicio de Anestesiología, Hospital Mar-Esperança, Parc de Salut Mar, Barcelona, España.
Rev Esp Anestesiol Reanim. 2012 Apr;59(4):180-6. doi: 10.1016/j.redar.2012.02.006. Epub 2012 May 1.
Surgical bleeding. transfusion rate and cardiovascular complications were analized in patients undergoing chronic treatment with low-doses aspirin and scheduled to unilateral primary knee arthroplasty.
We retrospectively studied 117 patients between 2005 and 2006 scheduled for elective knee replacement that received antiplatelet therapy with aspirin (100mg/day). Aspirin medication was maintained or discontinued preoperatively according to medical criteria. We analyzed the biological, clinical and anesthetic data, blood-saving techniques used, surgical bleeding, allogeneic blood transfusion rate, cardiocirculatory complications (myocardial, cerebral or peripheral ischemia), hospital stay and mortality. This population was compared with 190 patients (control group) who underwent the same operation at the same time interval but did not receive aspirin therapy.
The aspirin-treated group was significantly older, with higher weight and poorer health state (higher incidence of ischemic heart disease, cerebral ischemia and diabetes). The hidden and external surgical bleeding and transfusion rate were similar if the aspirin were interrupted or not, preoperatively. Bleeding and transfusion rates were independent of time of interruption of the aspirin. Hospital mortality was zero in the 2 groups. A acute myocardial infarction and a transient stroke happened in two patients wich aspirin treatment was discontinued.
Preoperative treatment with low doses of aspirin does not increase surgical bleeding and transfusion rate in total knee arthroplasty. Preoperative discontinuation can cause severe cardiocirculatory complications.
分析接受低剂量阿司匹林长期治疗且计划进行单侧初次膝关节置换术患者的手术出血情况、输血率及心血管并发症。
我们回顾性研究了2005年至2006年间计划进行择期膝关节置换术且接受阿司匹林（100毫克/天）抗血小板治疗的117例患者。阿司匹林用药根据医学标准在术前维持或停用。我们分析了生物学、临床和麻醉数据、所采用的血液节约技术、手术出血、异体输血率、心脏循环并发症（心肌、脑或外周缺血）、住院时间和死亡率。将该人群与190例在相同时间间隔内进行相同手术但未接受阿司匹林治疗的患者（对照组）进行比较。
阿司匹林治疗组年龄显著更大，体重更高，健康状况更差（缺血性心脏病、脑缺血和糖尿病发病率更高）。术前阿司匹林是否中断，隐匿性和外源性手术出血及输血率相似。出血和输血率与阿司匹林中断时间无关。两组住院死亡率均为零。在两名停用阿司匹林治疗的患者中发生了1例急性心肌梗死和1例短暂性中风。
低剂量阿司匹林术前治疗不会增加全膝关节置换术的手术出血和输血率。术前停药可能导致严重的心脏循环并发症。
