Bottle Alex, Oragui Emeka, Pinder Elizabeth, Aylin Paul, Loeffler Mark
Department of Primary Care and Public Health, Dr Foster Unit at Imperial College London, London, UK.
Department of Orthopaedics, Colchester General Hospital, Colchester, Essex, UK.
Arthroplast Today. 2015 Jun 23;1(2):45-50. doi: 10.1016/j.artd.2015.03.004. eCollection 2015 Jun.
The efficacy and safety of the new oral anticoagulants (NOAC) and the benefits of extended duration thromboprophylaxis following hip and knee replacements remain uncertain. This observational study describes the relations between thromboprophylaxis policies following hip and knee replacements across England's NHS and patient outcomes between January 2008 and December 2011. From the national administrative database, we analyzed mortality, thromboembolic complications, emergency readmission, and bleeding rates for 201,418 hip and 230,282 knee replacements. There were no differences in outcomes for either LMWH or NOAC. We found no advantage in favor of any single anticoagulation policy or in changing policy. This study supports the American Academy of Orthopaedic Surgeons' recommendation that the choice and duration of thromboprophylaxis prophylaxis be decided by the treating surgeon.
新型口服抗凝剂（NOAC）的疗效和安全性，以及髋关节和膝关节置换术后延长预防血栓形成的益处仍不明确。这项观察性研究描述了2008年1月至2011年12月期间，英格兰国民保健服务体系（NHS）中髋关节和膝关节置换术后的血栓预防策略与患者预后之间的关系。我们从国家行政数据库中分析了201,418例髋关节置换手术和230,282例膝关节置换手术的死亡率、血栓栓塞并发症、急诊再入院率和出血率。低分子肝素（LMWH）和NOAC的预后没有差异。我们没有发现任何单一抗凝策略或改变策略有优势。这项研究支持美国矫形外科医师学会的建议，即血栓预防的选择和持续时间应由主刀医生决定。
