Azboy I, Barrack R, Thomas A M, Haddad F S, Parvizi J
Rothman Institute at Thomas Jefferson University Hospital, Sheridan Building, Suite 1000, 125 South 9th Street, Philadelphia, PA 19107, USA.
Washington University Orthopedics, Barnes Jewish Hospital, 660 South Euclid Avenue, Campus Box 8233, St. Louis, Missouri 63110, USA.
Bone Joint J. 2017 Nov;99-B(11):1420-1430. doi: 10.1302/0301-620X.99B11.BJJ-2017-0337.R2.
The number of arthroplasties being performed increases each year. Patients undergoing an arthroplasty are at risk of venous thromboembolism (VTE) and appropriate prophylaxis has been recommended. However, the optimal protocol and the best agent to minimise VTE under these circumstances are not known. Although many agents may be used, there is a difference in their efficacy and the risk of bleeding. Thus, the selection of a particular agent relies on the balance between the desire to minimise VTE and the attempt to reduce the risk of bleeding, with its undesirable, and occasionally fatal, consequences. Acetylsalicylic acid (aspirin) is an agent for VTE prophylaxis following arthroplasty. Many studies have shown its efficacy in minimising VTE under these circumstances. It is inexpensive and well-tolerated, and its use does not require routine blood tests. It is also a 'milder' agent and unlikely to result in haematoma formation, which may increase both the risk of infection and the need for further surgery. Aspirin is also unlikely to result in persistent wound drainage, which has been shown to be associated with the use of agents such as low-molecular-weight heparin (LMWH) and other more aggressive agents. The main objective of this review was to summarise the current evidence relating to the efficacy of aspirin as a VTE prophylaxis following arthroplasty, and to address some of the common questions about its use. There is convincing evidence that, taking all factors into account, aspirin is an effective, inexpensive, and safe form of VTE following arthroplasty in patients without a major risk factor for VTE, such as previous VTE. Cite this article: 2017;99-B:1420-30.
每年进行的关节置换手术数量都在增加。接受关节置换手术的患者有发生静脉血栓栓塞（VTE）的风险，因此推荐进行适当的预防。然而，在这种情况下，尚不清楚将VTE降至最低的最佳方案和最佳药物。尽管可以使用多种药物，但其疗效和出血风险存在差异。因此，选择特定药物取决于将VTE降至最低的愿望与降低出血风险（及其不良后果，偶尔甚至是致命后果）的尝试之间的平衡。乙酰水杨酸（阿司匹林）是关节置换术后预防VTE的一种药物。许多研究表明，在这种情况下它在降低VTE方面具有疗效。它价格低廉且耐受性良好，使用时无需常规血液检查。它也是一种“较温和”的药物，不太可能导致血肿形成，而血肿可能会增加感染风险和进一步手术的必要性。阿司匹林也不太可能导致持续的伤口引流，而持续伤口引流已被证明与使用低分子量肝素（LMWH）等药物及其他更具侵袭性的药物有关。本综述的主要目的是总结目前有关阿司匹林作为关节置换术后预防VTE疗效的证据，并解答一些关于其使用的常见问题。有令人信服的证据表明，综合考虑所有因素，对于没有VTE主要危险因素（如既往VTE）的患者，阿司匹林是关节置换术后预防VTE的一种有效、廉价且安全的药物。引用本文：2017；99 - B：1420 - 30。
