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移动泵预防深静脉血栓形成:对药物说不。

Mobile pump deep vein thrombosis prophylaxis: just say no to drugs.

作者信息

Haynes J, Barrack R L, Nam D

机构信息

Washington University Orthopedics, Barnes Jewish Hospital, 660 S. Euclid Avenue, Campus Box 8233, St. Louis, MO, 63110, USA.

出版信息

Bone Joint J. 2017 Jan;99-B(1 Supple A):8-13. doi: 10.1302/0301-620X.99B1.BJJ-2016-0165.R1.

Abstract

AIMS

The purpose of this article was to review the current literature pertaining to the use of mobile compression devices (MCDs) for venous thromboembolism (VTE) following total joint arthroplasty (TJA), and to discuss the results of data from our institution.

PATIENTS AND METHODS

Previous studies have illustrated higher rates of post-operative wound complications, re-operation and re-admission with the use of more aggressive anticoagulation regimens, such as warfarin and factor Xa inhibitors. This highlights the importance of the safety, as well as efficacy, of the chemoprophylactic regimen.

RESULTS

Studies have shown a symptomatic VTE rate of 0.92% with use of MCDs for prophylaxis, which is comparable with rates seen with more aggressive anticoagulation protocols. A prior prospective study found that use of a pre-operative risk stratification protocol based on personal history of deep vein thrombosis, family history of VTE, active cancer, or a hypercoaguable state allowed for the avoidance of aggressive prophylactic anticoagulation in over 70% of patients while maintaining a low incidence of symptomatic VTE.

CONCLUSION

Further investigation is needed into the role of aspirin in VTE prophylaxis as well as the efficacy of MCDs as stand-alone prophylactic treatment. Cite this article: Bone Joint J 2017;99-B(1 Supple A):8-13.

摘要

目的

本文旨在回顾目前有关全关节置换术(TJA)后使用移动加压装置(MCD)预防静脉血栓栓塞症(VTE)的文献,并讨论我们机构的数据结果。

患者与方法

既往研究表明,使用华法林和Xa因子抑制剂等更积极的抗凝方案会导致术后伤口并发症、再次手术和再次入院的发生率更高。这凸显了化学预防方案安全性和有效性的重要性。

结果

研究显示,使用MCD进行预防时,有症状的VTE发生率为0.92%,这与采用更积极的抗凝方案时的发生率相当。一项先前的前瞻性研究发现,基于深静脉血栓形成个人史、VTE家族史、活动性癌症或高凝状态的术前风险分层方案,可使70%以上的患者避免积极的预防性抗凝,同时保持有症状VTE的低发生率。

结论

需要进一步研究阿司匹林在VTE预防中的作用以及MCD作为单一预防治疗的疗效。引用本文:《骨与关节杂志》2017年;99 - B(增刊A):8 - 13。

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