Perth Orthopaedic Institute; Fremantle Hospital; University of Sydney.
Hollywood Private Hospital, Nedlands, Perth, Western Australia.
J Arthroplasty. 2018 Jan;33(1):224-229. doi: 10.1016/j.arth.2017.07.046. Epub 2017 Aug 3.
The benefits vs risk of pharmacological prophylaxis for thromboembolic disease in orthopedic patients remain controversial. Pharmacological thromboprophylaxis regimes are commonly used in this patient group. Few studies specifically examine wound complications attributable to this therapy. In this prospective trial, we investigated the effect of various regimens on postoperative wounds.
A prospective, observational, multicenter study involving patients undergoing elective hip or knee arthroplasty was undertaken. Patients were divided into 3 groups depending on thromboprophylaxis: no anticoagulation, aspirin, or low molecular weight heparin (LMWH) (enoxaparin). Surgical wounds were evaluated for each regime using the Southampton Wound Assessment Score.
Over a 12-month period, 327 patients were enrolled with a mean age of 68.1 years (±11.2 years). There were 105 patients in the no anticoagulation group (32.1%), 97 patients in the aspirin group (29.7%), and 125 patients in the LMWH group (38.2%). Wound scores were evaluated for evidence and amount of discharge. The use of LMWH conferred a 4.92 times greater risk and aspirin a 3.64 times greater risk of wound discharge than no pharmacological thromboprophylaxis (P < .0001). There were no significant differences in the incidence of deep vein thrombosis or pulmonary embolus between groups either as an inpatient or postdischarge.
There is a significant increase in the risk of wound discharge when aspirin or LMWH is used in arthroplasty patients. As potential complications of wound problems are significant, a more balanced view of risk vs benefit needs to be taken when prescribing thromboprophylaxis for this patient group.
在骨科患者中，预防血栓栓塞性疾病的药物治疗的获益与风险仍然存在争议。在这类患者中，通常会使用药物性血栓预防方案。很少有研究专门针对与该治疗相关的伤口并发症进行研究。在这项前瞻性试验中，我们调查了各种方案对术后伤口的影响。
进行了一项涉及择期髋关节或膝关节置换术患者的前瞻性、观察性、多中心研究。根据血栓预防措施将患者分为 3 组：无抗凝、阿司匹林或低分子肝素（依诺肝素）。使用南安普顿伤口评估评分（Southampton Wound Assessment Score）对每种方案的手术伤口进行评估。
在 12 个月的时间内，共纳入 327 例患者，平均年龄为 68.1 岁（±11.2 岁）。无抗凝组 105 例（32.1%）、阿司匹林组 97 例（29.7%）和低分子肝素组 125 例（38.2%）。评估伤口评分以确定是否存在和量的分泌物。与无药物性血栓预防相比，使用低分子肝素使伤口分泌物的风险增加了 4.92 倍，而使用阿司匹林则使伤口分泌物的风险增加了 3.64 倍（P<0.0001）。无论是在住院期间还是出院后，各组之间深静脉血栓形成或肺栓塞的发生率均无显著差异。
在关节置换术患者中使用阿司匹林或低分子肝素会显著增加伤口分泌物的风险。由于伤口问题的潜在并发症很严重，因此在为该患者群体开具血栓预防药物时，需要更加平衡地考虑风险与获益。
