Houston Methodist Hospital, Houston, TX.
Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX.
Am J Health Syst Pharm. 2019 May 17;76(Supplement_2):S55-S60. doi: 10.1093/ajhp/zxy080.
The risks of venous thromboembolism (VTE) and bleeding with direct oral anticoagulants (DOACs) and aspirin for thromboprophylaxis after orthopedic surgery were studied.
A single center, retrospective study was conducted to examine patients who underwent a major orthopedic surgery from 2011 to 2015. The primary endpoint evaluated was the net clinical outcome of bleeding and thrombosis rates between the DOAC and aspirin groups. Secondary endpoints included bleeding rates, thrombosis rates, transfusion rates, and 90-day readmission rates. The primary endpoint was analyzed using adjusted logistic regression model with propensity score added as an independent variable.
A total of 420 patients were included in this study. The proportion of patients with composite primary outcome was similar between the groups (12.9% and 13.3%, in the DOAC and aspirin groups, respectively; p > 0.5). VTE events were numerically lower in the DOAC group, but the result was not statistically significant. Readmission due to VTE or bleeding and bleeding events were also similar between the groups. The DOAC group had a higher proportion of blood transfusions of at least 2 units of blood postoperatively compared with the aspirin group (p = 0.04).
No difference in net clinical outcome was observed in patients who received a DOAC or aspirin for VTE prophylaxis after major orthopedic surgery.
研究骨科手术后使用直接口服抗凝剂（DOAC）和阿司匹林进行血栓预防的静脉血栓栓塞（VTE）和出血风险。
进行了一项单中心回顾性研究，以检查 2011 年至 2015 年期间接受重大骨科手术的患者。评估的主要终点是 DOAC 和阿司匹林组之间出血和血栓形成率的净临床结局。次要终点包括出血率、血栓形成率、输血率和 90 天再入院率。使用调整后的逻辑回归模型分析主要终点，并将倾向评分作为独立变量添加。
本研究共纳入 420 例患者。两组复合主要结局的患者比例相似（分别为 DOAC 组 12.9%和阿司匹林组 13.3%；p>0.5）。DOAC 组的 VTE 事件发生率略低，但结果无统计学意义。VTE 或出血再入院和出血事件也在两组之间相似。与阿司匹林组相比，DOAC 组术后至少接受 2 单位血液输血的比例更高（p=0.04）。
在接受重大骨科手术后接受 DOAC 或阿司匹林进行 VTE 预防的患者中，未观察到净临床结局的差异。
