Hwang Jin-Young, Oh Sohee, Kim Chong-Soo, Chang Jee-Eun, Min Seong-Won
Department of Anesthesiology and Pain Medicine Department of Biostatistics, SMG-SNU Boramae Medical Center, Boramae-ro, Dongjak-gu, Seoul, Republic of Korea.
Medicine (Baltimore). 2016 Nov;95(48):e5487. doi: 10.1097/MD.0000000000005487.
The number of elderly patients undergoing total knee arthroplasty (TKA) has steadily increased. Elderly patients undergoing TKA usually have underlying diseases, and some of them take antithrombotic agents for the prevention or treatment of these co-morbidities, including cardiovascular, cerebrovascular, or thromboembolic diseases. When these patients are scheduled to undergo TKA, preoperative cessation of antithrombotic agents is considered on the basis of its risks and benefits. This study was aimed to evaluate the impact of discontinuing antithrombotic agents for primary total knee arthroplasty (TKA) on perioperative complications.Patients who underwent primary TKA between 2008 and 2012 were identified, and classified into two groups: group A, in whom antithrombotic agents were ceased preoperatively, and group B, in which patients did not receive antithrombotic therapy. Patient characteristics, history of antithrombotic therapy, intraoperative blood loss, perioperative blood transfusion, postoperative 30-day complications, and postoperative hospital stay were recorded.Of 885 patients undergoing primary TKA, 218 (24.6%) patients were included in group A, and 667 (75.4%) in group B. Group A received transfusion more frequently than group B (P < 0.001). However, there was no difference between the two groups in terms of intraoperative blood loss, postoperative 30-day complications, and postoperative hospital stay.Patients who discontinued antithrombotic drugs before primary TKA do not have a higher incidence of postoperative 30-day complications, including cardiovascular, cerebrovascular, or thromboembolic events. Moreover, the estimated intraoperative blood loss was not different compared with patients not receiving antithrombotic agents preoperatively. Larger prospective studies of this issue are required.
接受全膝关节置换术（TKA）的老年患者数量一直在稳步增加。接受TKA的老年患者通常患有基础疾病，其中一些人服用抗血栓药物来预防或治疗这些合并症，包括心血管、脑血管或血栓栓塞性疾病。当这些患者计划接受TKA时，会根据抗血栓药物的风险和益处考虑术前停用。本研究旨在评估原发性全膝关节置换术（TKA）停用抗血栓药物对围手术期并发症的影响。
确定了2008年至2012年间接受原发性TKA的患者，并将其分为两组：A组，术前停用抗血栓药物；B组，未接受抗血栓治疗。记录患者特征、抗血栓治疗史、术中失血、围手术期输血、术后30天并发症和术后住院时间。
在885例接受原发性TKA的患者中，218例（24.6%）纳入A组，667例（75.4%）纳入B组。A组输血频率高于B组（P<0.001）。然而，两组在术中失血、术后30天并发症和术后住院时间方面没有差异。
原发性TKA术前停用抗血栓药物的患者术后30天并发症（包括心血管、脑血管或血栓栓塞事件）的发生率并不更高。此外，与术前未接受抗血栓药物的患者相比，估计的术中失血量没有差异。需要对此问题进行更大规模的前瞻性研究。
