Department of Orthopaedic Surgery, Hospital for Special Surgery and Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA.
Int Orthop. 2012 Oct;36(10):1995-2002. doi: 10.1007/s00264-012-1588-4. Epub 2012 Jun 12.
Multimodal thromboprophylaxis includes preoperative thromboembolic risk stratification and autologous blood donation, surgery performed under regional anaesthesia, postoperative rapid mobilisation, use of pneumatic compression devices and chemoprophylaxis tailored to the patient's individual risk. We determined the 90-day rate of venous thromboembolism (VTE), other complications and mortality in patients who underwent primary elective hip and knee replacement surgery with multimodal thromboprophylaxis.
A total of 1,568 consecutive patients undergoing hip and knee replacement surgery received multimodal thromboprophylaxis: 1,115 received aspirin, 426 received warfarin and 27 patients received low molecular weight heparin and warfarin with or without a vena cava filter.
The rate of VTE, pulmonary embolism, proximal deep vein thrombosis (DVT) and distal DVT was 1.2, 0.36, 0.45 and 0.36 %, respectively, in patients who received aspirin. The rates in those who received warfarin were 1.4, 0.9, 0.47 and 0.47 %, respectively. The overall 90-day mortality rate was 0.2 %.
Multimodal thromboprophylaxis in which aspirin is administered to low-risk patients is safe and effective following primary total joint replacement.
多模式血栓预防包括术前血栓栓塞风险分层和自体献血、在区域麻醉下进行手术、术后快速活动、使用气动压缩设备以及针对患者个体风险的化学预防。我们确定了在多模式血栓预防下接受初次择期髋关节和膝关节置换手术的患者在 90 天内静脉血栓栓塞 (VTE)、其他并发症和死亡率的发生率。
共有 1568 例连续接受髋关节和膝关节置换手术的患者接受了多模式血栓预防：1115 例患者接受阿司匹林，426 例患者接受华法林，27 例患者接受低分子肝素和华法林，同时或不使用腔静脉滤器。
接受阿司匹林的患者中 VTE、肺栓塞、近端深静脉血栓形成 (DVT) 和远端 DVT 的发生率分别为 1.2%、0.36%、0.45%和 0.36%。接受华法林的患者中 VTE、肺栓塞、近端 DVT 和远端 DVT 的发生率分别为 1.4%、0.9%、0.47%和 0.47%。总的 90 天死亡率为 0.2%。
在初次全关节置换术后，给予低风险患者阿司匹林的多模式血栓预防是安全有效的。
