韩国全膝关节和全髋关节置换术后的药物性血栓预防及其对静脉血栓栓塞的影响：一项基于全国人口的研究。

Pharmacological thromboprophylaxis and its impact on venous thromboembolism following total knee and hip arthroplasty in Korea: A nationwide population-based study.

作者信息

Yhim Ho-Young, Lee Juhyun, Lee Ji Yun, Lee Jeong-Ok, Bang Soo-Mee

机构信息

Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.

Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.

出版信息

PLoS One. 2017 May 24;12(5):e0178214. doi: 10.1371/journal.pone.0178214. eCollection 2017.

DOI:10.1371/journal.pone.0178214

PMID:28542415

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5443574/

Abstract

BACKGROUND

Limited data is available regarding the pharmacological prophylaxis for venous thromboembolism (VTE) in Asian patients undergoing total knee arthroplasty or total hip arthroplasty (TKA/THA).

METHODS

We performed a population-based epidemiological study using the Health Insurance Review and Assessment Service database to estimate the rate of pharmacological thromboprophylaxis and its impact on VTE in Korean patients who underwent TKA/THA between 2009 and 2013.

RESULTS

We identified 306,912 cases (TKA, 261,260; THA, 45,652). The pharmacological thromboprophylaxis rate was 57.16% (TKA, 58.32%; THA, 50.51%), which increased from 42.81% in 2009 to 65.92% in 2013 (P = 0.0165). Both low-molecular-weight-heparin (22.42%) and rivaroxaban (22.71%) were the most common drugs for prophylaxis. The number of patients aged ≥ 60 years (87.31% vs. 81.01%, P < 0.0001), cases requiring general anesthesia (20.70% vs. 18.37%, P < 0.0001), and cases requiring long hospital stay (median, 13 days vs. 12 days, P < 0.0001) were significantly greater in the pharmacological prophylaxis group. The incidence of VTE within 3 months of surgery was 1.52% (TKA, 1.46%; THA, 1.87%). Patients with pharmacological prophylaxis had higher VTE rates (TKA, 1.69% vs. 1.14%; THA, 2.30% vs. 1.43%) than those without prophylaxis, with advanced age, use of general anesthesia, and a longer hospital stay increasing the risk of VTE. However, rivaroxaban significantly reduced the incidence of VTE following TKA (0.82% vs. 1.14%; odd ratio [OR], 0.72; 95% CI, 0.65-0.79). Moreover, ≥ 10 days of pharmacological thromboprophylaxis was significantly associated with lower incidence of VTE after TKA (1.33% vs. 1.52%; OR, 0.87; 95% CI, 0.81-0.94).

CONCLUSION

This represents the largest epidemiological study showing a gradual increase in the use of pharmacological prophylaxis in Korean patients undergoing TKA/THA. Although the incidence of VTE is still low without pharmacological prophylaxis, this study demonstrates that the incidence of VTE can be reduced further using appropriate pharmacological thromboprophylaxis strategies.

摘要

背景

关于亚洲患者在接受全膝关节置换术或全髋关节置换术（TKA/THA）时进行静脉血栓栓塞（VTE）药物预防的数据有限。

方法

我们利用健康保险审查与评估服务数据库进行了一项基于人群的流行病学研究，以评估2009年至2013年间接受TKA/THA的韩国患者的药物血栓预防率及其对VTE的影响。

结果

我们确定了306,912例病例（TKA为261,260例；THA为45,652例）。药物血栓预防率为57.16%（TKA为58.32%；THA为50.51%），从2009年的42.81%上升至2013年的65.92%（P = 0.0165）。低分子量肝素（22.42%）和利伐沙班（22.71%）都是最常用的预防药物。在药物预防组中，年龄≥60岁的患者数量（87.31%对81.01%，P < 0.0001）、需要全身麻醉的病例（20.70%对18.37%，P < 0.0001）以及需要较长住院时间的病例（中位数为13天对12天，P < 0.0001）显著更多。术后3个月内VTE的发生率为1.52%（TKA为1.46%；THA为1.87%）。接受药物预防的患者VTE发生率高于未接受预防的患者（TKA为1.69%对1.14%；THA为2.30%对1.43%），高龄、使用全身麻醉和较长住院时间会增加VTE风险。然而，利伐沙班显著降低了TKA后VTE的发生率（0.82%对1.14%；比值比[OR]为0.72；95%置信区间[CI]为0.65 - 0.79）。此外，≥10天的药物血栓预防与TKA后VTE发生率较低显著相关（1.33%对1.52%；OR为0.87；95% CI为0.81 - 0.94）。