Rosenman Marc, Liu Xianchen, Phatak Hemant, Qi Rong, Teal Evgenia, Nisi Daniel, Liu Larry Z, Parr J Andrew
1Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN; 2Regenstrief Institute, Indianapolis, IN; 3Global Health Economics and Outcome Research, Pfizer, Inc, New York, NY; 4Global Health Economics and Outcome Research, Bristol-Myers Squibb, Co, Lawrenceville, NJ; 5Weill Medical College of Cornell University, New York, NY; and 6Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN.
Am J Ther. 2016 Mar-Apr;23(2):e336-44. doi: 10.1097/01.mjt.0000433946.78535.84.
Patients who have total hip (THR) or knee (TKR) replacement have an elevated risk of venous thromboembolism (VTE). The American College of Chest Physicians guidelines recommend prophylactic anticoagulation. The aim of the study was to examine pharmacologic prophylaxis against VTE among patients with THR or TKR and to assess demographic and clinical correlates related to VTE prophylaxis. Using 15 years of data (1995-2009) from an electronic medical record system for an inner-city public hospital in the United States, we examined pharmacologic prophylaxis against VTE and associated factors in patients after THR (n = 242) and TKR (n = 317). Before the early 2000s, aspirin was the most common prophylaxis agent (THR, 61% and TKR, 65%), and 26% of patients with THR and 19% of patients with TKR did not receive prophylaxis. Enoxaparin use has increased since 2000, and warfarin is now the most common prophylaxis agent (THR, 70% and TKR, 61%). After controlling for time period, factors associated with prophylaxis pattern included obesity, hip fracture, and the surgeon's number of years in practice. VTE prophylaxis medications in patients with total joint replacement have changed over 15 years, in trends generally consistent with the evolution of guidelines. Obesity, history of hip fracture, and physician's experience are associated with the prescription of VTE prophylaxis medications.
接受全髋关节置换术（THR）或全膝关节置换术（TKR）的患者发生静脉血栓栓塞（VTE）的风险升高。美国胸科医师学会指南推荐进行预防性抗凝治疗。本研究的目的是检查THR或TKR患者中预防VTE的药物治疗情况，并评估与VTE预防相关的人口统计学和临床因素。利用美国一家市中心公立医院电子病历系统15年（1995 - 2009年）的数据，我们检查了THR（n = 242）和TKR（n = 317）患者预防VTE的药物治疗及相关因素。在21世纪初之前，阿司匹林是最常用的预防药物（THR患者中占61%，TKR患者中占65%），并且26%的THR患者和19%的TKR患者未接受预防治疗。自2000年以来，依诺肝素的使用有所增加，目前华法林是最常用的预防药物（THR患者中占70%，TKR患者中占61%）。在控制了时间段后，与预防模式相关的因素包括肥胖、髋部骨折以及外科医生的执业年限。全关节置换患者的VTE预防药物在15年中发生了变化，总体趋势与指南的演变一致。肥胖、髋部骨折病史以及医生经验与VTE预防药物的处方有关。
