Tsukada Sachiyuki, Kurosaka Kenji, Nishino Masahiro, Maeda Tetsuyuki, Hirasawa Naoyuki
Departments of Orthopaedic Surgery (S.T., K.K., M.N., and N.H.) and Anesthesiology (T.M.), Hokusuikai Kinen Hospital, Ibaraki, Japan.
JB JS Open Access. 2019 Jul 16;4(3). doi: 10.2106/JBJS.OA.18.00057. eCollection 2019 Jul-Sep.
Although continuing antithrombotic therapy is desirable to prevent perioperative cardiovascular and cerebrovascular diseases, perioperative blood loss remains a concern in patients undergoing total knee arthroplasty. The purpose of this study was to assess the impact of continuing chronic antithrombotic therapy on blood loss and major bleeding events.
We classified 201 consecutive patients undergoing total knee arthroplasty into 2 groups: (1) patients taking antiplatelet agents, vitamin K antagonists, and/or direct oral anticoagulants, referred to as the continuing antithrombotic therapy group (n = 32); and (2) patients not receiving these agents, referred to as the no antithrombotic therapy group (n = 169). During the study period, antithrombotic agents were continued perioperatively in all patients receiving antithrombotic therapy. Surgical procedures were performed without the use of a pneumatic tourniquet or drain. Screening for deep vein thrombosis was routinely performed before and after total knee arthroplasty. The total perioperative blood loss was calculated from blood volume and change in hemoglobin from preoperatively to postoperative days 1, 3, and 7.
The perioperative blood loss after total knee arthroplasty did not differ significantly between the continuing antithrombotic therapy group and the no antithrombotic therapy group at 1 day postoperatively (448 ± 213 compared with 495 ± 345 mL [95% confidence interval (CI) of the difference, -172 to 77 mL]; p = 0.45), 3 days postoperatively (841 ± 308 compared with 826 ± 328 mL [95% CI, -108 to 139 mL]; p = 0.81), and 7 days postoperatively (855 ± 313 compared with 861 ± 245 mL [95% CI, -122 to 108 mL]; p = 0.91). No patients in the continuing antithrombotic therapy group and 2 patients (1.2%) in the no antithrombotic therapy group had allogeneic blood transfusion (p = 1). No major bleeding events occurred in the continuing antithrombotic therapy group.
Perioperative blood loss in patients continuing chronic antithrombotic therapy during total knee arthroplasty was not significantly different from that in patients receiving no chronic antithrombotic therapy.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
尽管持续抗血栓治疗对于预防围手术期心血管和脑血管疾病是可取的，但围手术期失血仍是全膝关节置换术患者关注的问题。本研究的目的是评估持续慢性抗血栓治疗对失血和严重出血事件的影响。
我们将201例连续接受全膝关节置换术的患者分为两组：（1）服用抗血小板药物、维生素K拮抗剂和/或直接口服抗凝剂的患者，称为持续抗血栓治疗组（n = 32）；（2）未接受这些药物的患者，称为无抗血栓治疗组（n = 169）。在研究期间，所有接受抗血栓治疗的患者在围手术期继续使用抗血栓药物。手术过程中不使用气动止血带或引流管。全膝关节置换术前和术后常规进行深静脉血栓筛查。围手术期总失血量根据血容量以及术前至术后第1、3和7天血红蛋白的变化来计算。
全膝关节置换术后1天（分别为448 ± 213与495 ± 345 mL [差异的95%置信区间（CI），-172至77 mL]；p = 0.45）、术后3天（841 ± 308与826 ± 328 mL [95% CI，-108至139 mL]；p = 0.81）和术后7天（855 ± 313与861 ± 245 mL [95% CI，-122至108 mL]；p = 0.91），持续抗血栓治疗组和无抗血栓治疗组的围手术期失血量无显著差异。持续抗血栓治疗组无患者接受异体输血，无抗血栓治疗组有2例患者（1.2%）接受异体输血（p = 1）。持续抗血栓治疗组未发生严重出血事件。
全膝关节置换术期间继续进行慢性抗血栓治疗的患者围手术期失血量与未接受慢性抗血栓治疗的患者无显著差异。
治疗水平III。有关证据水平的完整描述，请参阅作者指南。
