Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio; Departamento de cirugía ortopédica, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
J Arthroplasty. 2018 Jul;33(7S):S131-S135. doi: 10.1016/j.arth.2018.03.001. Epub 2018 Mar 8.
Aspirin is an effective prophylaxis for venous thromboembolism (VTE) after total knee arthroplasty (TKA). The optimal prophylactic aspirin dose has not been established. The study aims to compare 2 aspirin regimens with regard to the incidence of (1) symptomatic deep venous thrombosis (DVT), (2) pulmonary embolism (PE), (3) bleeding, and (4) mortality within 90 days after TKA.
We retrospectively identified 5666 patients who received aspirin twice daily for 4 to 6 weeks after TKA. A total of 1327 patients received 81-mg BID and 4339 patients received 325-mg BID aspirin. Postoperative complications collected were VTEs (DVT and PE), bleeding (gastrointestinal or wound bleeding), and mortality.
The incidence of VTE was 1.5% in the 325-mg group and 0.7% in the 81-mg group (P = .02). Symptomatic DVT was 1.4% in the 325-mg aspirin compared with 0.3% for the 81-mg aspirin (P = .0009). Regression model showed no correlation between aspirin dose and VTE incidence (odds ratio [OR] = 1.03; 95% confidence interval [95% CI], 0.45-2.36; P = .94) or DVT (OR = 0.50; 95% CI, 0.16-1.55; P = .20). The incidence of PE was 0.2% in the high-aspirin group compared with 0.4% in the low-aspirin group (P = .13). Bleeding was 0.2% in the 325-mg aspirin group and 0.2% in the 81-mg aspirin group (P = .62), and 90-day mortality was similar (0.1%) between the groups (P = .56).
Low-dose aspirin was not inferior to high-dose aspirin for the prevention of VTE after TKA. Low-dose aspirin can be considered a safe and effective agent in the prevention of VTE after TKA.
阿司匹林是全膝关节置换术（TKA）后预防静脉血栓栓塞症（VTE）的有效药物。但最佳预防剂量尚未确定。本研究旨在比较两种阿司匹林方案在 TKA 后 90 天内（1）症状性深静脉血栓形成（DVT）、（2）肺栓塞（PE）、（3）出血和（4）死亡率方面的发生率。
我们回顾性确定了 5666 例接受 TKA 后每日两次服用阿司匹林 4-6 周的患者。共有 1327 例患者接受 81mg BID 阿司匹林，4339 例患者接受 325mg BID 阿司匹林。收集的术后并发症包括 VTE（DVT 和 PE）、出血（胃肠道或伤口出血）和死亡率。
325mg 组 VTE 的发生率为 1.5%，81mg 组为 0.7%（P =.02）。325mg 阿司匹林组症状性 DVT 发生率为 1.4%，81mg 阿司匹林组为 0.3%（P =.0009）。回归模型显示阿司匹林剂量与 VTE 发生率之间无相关性（比值比[OR] = 1.03；95%置信区间[95%CI]，0.45-2.36；P =.94）或 DVT（OR = 0.50；95%CI，0.16-1.55；P =.20）。高剂量阿司匹林组 PE 的发生率为 0.2%，低剂量阿司匹林组为 0.4%（P =.13）。325mg 阿司匹林组出血率为 0.2%，81mg 阿司匹林组为 0.2%（P =.62），两组 90 天死亡率相似（0.1%）（P =.56）。
低剂量阿司匹林预防 TKA 后 VTE 并不逊于高剂量阿司匹林。低剂量阿司匹林可作为 TKA 后预防 VTE 的安全有效药物。
