口服避孕药并非关节镜下肩部手术后发生深静脉血栓形成或肺栓塞的危险因素。
Oral Contraceptive Pills Are Not a Risk Factor for Deep Vein Thrombosis or Pulmonary Embolism After Arthroscopic Shoulder Surgery.
作者信息
Stone Austin V, Agarwalla Avinesh, Gowd Anirudh K, Jacobs Cale A, Macalena Jeffrey A, Lesniak Bryson P, Verma Nikhil N, Romeo Anthony A, Forsythe Brian
机构信息
Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA.
Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA.
出版信息
Orthop J Sports Med. 2019 Jan 28;7(1):2325967118822970. doi: 10.1177/2325967118822970. eCollection 2019 Jan.
BACKGROUND
Worldwide, more than 100 million women between the ages of 15 and 49 years take oral contraceptive pills (OCPs). OCP use increases the risk of venous thromboembolism (VTE) through its primary drug, ethinylestradiol, which slows liver metabolism, promotes tissue retention, and ultimately favors fibrinolysis inhibition and thrombosis.
PURPOSE
To evaluate the effects of OCP use on VTE after arthroscopic shoulder surgery.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
A large national payer database (PearlDiver) was queried for patients undergoing arthroscopic shoulder surgery. The incidence of VTE was evaluated in female patients taking OCPs and those not taking OCPs. A matched group was subsequently created to evaluate the incidence of VTE in similar patients with and without OCP use.
RESULTS
A total of 57,727 patients underwent arthroscopic shoulder surgery from 2007 to 2016, and 26,365 patients (45.7%) were female. At the time of surgery, 924 female patients (3.5%) were taking OCPs. The incidence of vascular thrombosis was 0.57% (n = 328) after arthroscopic shoulder surgery, and there was no significant difference in the rate of vascular thrombosis in male or female patients (0.57% vs 0.57%, respectively; > .99). The incidence of VTE in female patients taking and not taking OCPs was 0.22% and 0.57%, respectively ( = .2). In a matched-group analysis, no significant difference existed in VTE incidence between patients with versus without OCP use (0.22% vs 0.56%, respectively; = .2). On multivariate analysis, hypertension (odds ratio [OR], 2.00; < .001) and obesity (OR, 1.43; = .002) were risk factors for VTE.
CONCLUSION
OCP use at the time of arthroscopic shoulder surgery is not associated with an increased risk of VTE. Obesity and hypertension are associated with a greater risk for thrombolic events, although the risk remains very low. Our findings suggest that patients taking OCPs should be managed according to the surgeon's standard prophylaxis protocol for arthroscopic shoulder surgery.
背景
在全球范围内，超过1亿名年龄在15至49岁之间的女性服用口服避孕药（OCP）。OCP的主要药物炔雌醇会增加静脉血栓栓塞（VTE）的风险，它会减缓肝脏代谢，促进组织潴留，并最终有利于纤维蛋白溶解抑制和血栓形成。
目的
评估在肩关节镜手术后使用OCP对VTE的影响。
研究设计
队列研究；证据等级，3级。
方法
查询一个大型国家医保支付数据库（PearlDiver）中接受肩关节镜手术的患者。评估服用OCP的女性患者和未服用OCP的女性患者中VTE的发生率。随后创建一个匹配组，以评估使用和未使用OCP的相似患者中VTE的发生率。
结果
2007年至2016年共有57727例患者接受了肩关节镜手术，其中26365例（45.7%）为女性。手术时，924例女性患者（3.5%）正在服用OCP。肩关节镜手术后血管血栓形成的发生率为0.57%（n = 328），男性和女性患者的血管血栓形成率无显著差异（分别为0.57%和0.57%；P>0.99）。服用和未服用OCP的女性患者中VTE的发生率分别为0.22%和0.57%（P = 0.2）。在匹配组分析中，使用和未使用OCP的患者之间VTE发生率无显著差异（分别为0.22%和0.56%；P = 0.2）。多因素分析显示，高血压（比值比[OR]，2.00；P<0.001）和肥胖（OR，1.43；P = 0.002）是VTE的危险因素。
结论
肩关节镜手术时使用OCP与VTE风险增加无关。肥胖和高血压与血栓形成事件的风险增加有关，尽管风险仍然很低。我们的研究结果表明，服用OCP的患者应按照外科医生针对肩关节镜手术的标准预防方案进行管理。
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