An Vincent V G, Levy Yadin D, Walker Peter M, Bruce Warwick J M
Faculty of Medicine, University of Sydney, Camperdown, Australia.
Sydney Olympic Park Hip and Knee Clinic, Sydney Olympic Park, Australia.
J Clin Orthop Trauma. 2020 Mar;11(Suppl 2):S187-S191. doi: 10.1016/j.jcot.2018.10.007. Epub 2018 Oct 16.
Venous thromboembolism (VTE) (Deep vein thrombosis (DVT), and pulmonary embolism (PE)), is a common complication in patients undergoing total joint arthroplasty (TJA). Recently, aspirin was recommended by the American Academy of Orthopaedic Surgeons (AAOS) as VTE prophylaxis following TJA. This study investigates VTE rates in TJA patients using as thromboprophylaxis.
DVT was screened for in 396 consecutive total hip or knee arthroplasty procedures. Patients were treated with early mobilisation, calf compression device and 300 mg aspirin for 5 days and then 100 mg aspirin for 5 weeks. All patients received lower-limb duplex ultrasonography prior to discharge. Patients were clinically evaluated at 6 weeks post-op documenting any VTE.
51 TJA's (12.87%) were complicated by VTE: one proximal, 47 distal DVT and 3 PE. No fatal PE occurred. Only four DVT were symptomatic. Of 159 THA, 2 (1.25%) had VTE: one distal DVT and one PE. Of 237 TKA, 49 (20.67%) had VTE: 1 proximal, 46 distal DVT and 2 PE. Patients with a history of diabetes and those receiving TKA were at higher risk of DVT.
Multimodal VTE prophylaxis demonstrated a low rate of proximal DVT, PE and bleeding complications. The rate of asymptomatic DVT was high, but most were distal and unlikely to be clinically significant. Patients with diabetes and those receiving TKA could be at higher risk of asymptomatic DVT, and may benefit from closer clinical assessment. These findings suggest aspirin is safe and efficacious when used in combination with mechanical compressors and early mobilisation. However, our findings require further validation, particularly with larger, prospective comparative studies.
静脉血栓栓塞症（VTE）（深静脉血栓形成（DVT）和肺栓塞（PE））是全关节置换术（TJA）患者常见的并发症。最近，美国骨科医师学会（AAOS）推荐阿司匹林用于TJA术后的VTE预防。本研究调查了使用阿司匹林进行血栓预防的TJA患者的VTE发生率。
对396例连续的全髋关节或膝关节置换手术进行DVT筛查。患者接受早期活动、小腿压迫装置治疗，并服用300毫克阿司匹林5天，然后服用100毫克阿司匹林5周。所有患者出院前均接受下肢双功超声检查。术后6周对患者进行临床评估，记录任何VTE情况。
51例TJA（12.87%）发生VTE并发症：1例近端DVT、47例远端DVT和3例PE。未发生致命性PE。只有4例DVT有症状。在159例THA中，2例（1.25%）发生VTE：1例远端DVT和1例PE。在237例TKA中，49例（20.67%）发生VTE：1例近端DVT、46例远端DVT和2例PE。有糖尿病史的患者和接受TKA的患者发生DVT的风险更高。
多模式VTE预防显示近端DVT、PE和出血并发症的发生率较低。无症状DVT的发生率较高，但大多数为远端，可能不具有临床意义。糖尿病患者和接受TKA的患者发生无症状DVT的风险可能更高，可能受益于更密切的临床评估。这些发现表明，阿司匹林与机械压迫器和早期活动联合使用时是安全有效的。然而，我们的发现需要进一步验证，特别是通过更大规模的前瞻性对照研究。
