The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
J Bone Joint Surg Am. 2019 Mar 20;101(6):504-513. doi: 10.2106/JBJS.18.00143.
The use of aspirin as prophylaxis against venous thromboembolism (VTE) following total joint arthroplasty (TJA) has increased in popularity; however, the potential cardioprotective effects of aspirin when administered as VTE prophylaxis remain unknown. The present study investigated the influence of VTE prophylaxis, including aspirin, on mortality following TJA.
We retrospectively reviewed 31,133 patients who underwent primary TJA from 2000 to 2017. Patient demographics, body mass index, and comorbidities were obtained from an electronic chart query. Patients were allocated into 2 cohorts on the basis of the VTE prophylaxis administered: aspirin (25.9%, 8,061 patients) and non-aspirin (74.1%, 23,072 patients). Mortality was assessed with use of an institutional mortality database that is updated biannually. Univariate and multivariate regression analyses were performed.
The overall mortality rate was 0.2% and 0.6% at 30 days and 1 year after TJA, respectively. The use of aspirin was independently associated with lower risk of death at both 30 days (odds ratio [OR], 0.39; p = 0.020) and 1 year (OR, 0.51; p = 0.004). Patients in the non-aspirin cohort showed 3 times the risk of death at 30 days compared with the aspirin cohort (0.3% compared with 0.1%; p = 0.004), and twice the risk of death at 1 year (0.7% compared with 0.3%; p < 0.001). At 1 year, the primary cause of death in the non-aspirin group was cardiac-related (46 of 23,072, 0.20%). In the aspirin group, the rate of cardiac-related death was almost 5 times lower (3 of 8,061, 0.04%; p = 0.005). Risk factors for mortality at 1 year included higher age (p < 0.001), male sex (p = 0.020), history of congestive heart failure (p = 0.003), cerebrovascular disease (p < 0.001), malignancy (p < 0.001), and history of prior myocardial infarction (p < 0.001).
The present study demonstrates that the use of aspirin as prophylaxis against VTE following TJA may reduce the risk of mortality. Given the numerous options available and permitted by the current guidelines, orthopaedic surgeons should be aware of the potential added benefits of aspirin when selecting a VTE-prophylactic agent.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
在全膝关节置换术（TJA）后，阿司匹林作为静脉血栓栓塞症（VTE）预防的应用越来越普及；然而，阿司匹林作为 VTE 预防药物的潜在心脏保护作用尚不清楚。本研究调查了 VTE 预防（包括阿司匹林）对 TJA 后死亡率的影响。
我们回顾性分析了 2000 年至 2017 年期间接受初次 TJA 的 31133 例患者。从电子病历查询中获取患者的人口统计学资料、体重指数和合并症。根据给予的 VTE 预防药物将患者分为 2 组：阿司匹林组（25.9%，8061 例）和非阿司匹林组（74.1%，23072 例）。使用机构死亡率数据库每两年更新一次来评估死亡率。进行单变量和多变量回归分析。
术后 30 天和 1 年的总体死亡率分别为 0.2%和 0.6%。阿司匹林的使用与 30 天（比值比[OR]，0.39；p = 0.020）和 1 年（OR，0.51；p = 0.004）时的死亡风险降低独立相关。与阿司匹林组相比，非阿司匹林组在 30 天（0.3%比 0.1%；p = 0.004）和 1 年（0.7%比 0.3%；p < 0.001）时的死亡风险增加了 3 倍。在 1 年时，非阿司匹林组的主要死亡原因为心脏相关疾病（23072 例中有 46 例，0.20%）。在阿司匹林组中，心脏相关死亡的发生率几乎低了 5 倍（8061 例中有 3 例，0.04%；p = 0.005）。1 年时的死亡危险因素包括年龄较大（p < 0.001）、男性（p = 0.020）、充血性心力衰竭史（p = 0.003）、脑血管疾病（p < 0.001）、恶性肿瘤（p < 0.001）和既往心肌梗死史（p < 0.001）。
本研究表明，TJA 后使用阿司匹林预防 VTE 可能降低死亡率。鉴于目前指南允许的众多选择，骨科医生在选择 VTE 预防药物时应注意到阿司匹林可能带来的额外益处。
治疗性 III 级。欲了解完整的证据等级说明，请参见作者须知。
