口服抗凝治疗的桥接治疗会增加全关节置换术中与出血相关并发症的风险。

Bridging therapy for oral anticoagulation increases the risk for bleeding-related complications in total joint arthroplasty.

作者信息

Haighton Martijn, Kempen Diederik H R, Wolterbeek Nienke, Marting Louis N, van Dijk Martijn, Veen Remmelt M R

机构信息

Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430, EM, Utrecht, The Netherlands.

Department of Orthopaedic Surgery, OLVG Hospital, Oosterpark 9, 1091, AC, Amsterdam, The Netherlands.

出版信息

J Orthop Surg Res. 2015 Sep 17;10:145. doi: 10.1186/s13018-015-0285-6.

DOI:10.1186/s13018-015-0285-6

PMID:26384316

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4573310/

Abstract

BACKGROUND

Patients scheduled for elective surgery with a high risk of thromboembolism require anticoagulation bridging therapy perioperatively. The purpose of this study was to assess the risk of thromboembolic events and bleeding-related complications after total hip and knee arthroplasty in patients requiring bridging therapy for anticoagulants.

METHODS

A retrospective cohort study of all patients with primary total hip or total knee replacement in a 4-year period was performed. Outcome measures were blood loss, thromboembolic and bleeding-related complications and hospital stay.

RESULTS

Bridged patients had more blood loss and higher complication rates than the control group. Most complications were bleeding-related, and there were no thromboembolic events. Seven of the 14 (50%) total hip patients bridged with unfractioned heparin required reoperation (three patients with ischial neuropraxia due to hematoma). There were two bleeding-related deaths in total hip patients bridged with low-molecular-weight heparin. Mean hospital stay was significantly longer in unfractioned heparin bridging.

CONCLUSION

In this study, there was a significant increase in bleeding-related complications in total joint replacement with bridging therapy compared to prophylaxis. This risk was highest in patients with total hip arthroplasty. There were no thromboembolic events in bridged patients.

摘要

背景

计划接受择期手术且血栓栓塞风险高的患者在围手术期需要抗凝桥接治疗。本研究的目的是评估在需要抗凝桥接治疗的患者中，全髋关节和膝关节置换术后血栓栓塞事件及出血相关并发症的风险。

方法

对4年内所有行初次全髋关节或全膝关节置换术的患者进行回顾性队列研究。观察指标为失血量、血栓栓塞及出血相关并发症和住院时间。

结果

接受桥接治疗的患者比对照组有更多的失血量和更高的并发症发生率。大多数并发症与出血相关，且无血栓栓塞事件。14例接受普通肝素桥接治疗的全髋关节置换患者中有7例（50%）需要再次手术（3例因血肿导致坐骨神经失用）。接受低分子肝素桥接治疗的全髋关节置换患者中有2例因出血相关死亡。普通肝素桥接治疗组的平均住院时间显著更长。