Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania.
Department of Orthopaedics and Rehabilitation, Bone and Joint Institute, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
J Knee Surg. 2022 Mar;35(4):443-448. doi: 10.1055/s-0040-1715090. Epub 2020 Aug 31.
The incidence of symptomatic venous thromboembolism (VTE) has been reported in up to 10.9% of patients undergoing knee arthroscopy without chemoprohylaxis. The purpose of this study was to evaluate the effectiveness of a chemoprophylaxis protocol in patients undergoing knee arthroscopy. A retrospective review of prospectively enrolled patients in a new institutional VTE prophylaxis protocol identified all patients undergoing knee arthroscopy during a 5-year period. This risk-based chemoprophylaxis protocol was instituted based on the Caprini model: patients at more than minimal risk were prescribed enoxaparin 40 mg daily for 3 weeks, while all others were instructed to take aspirin 325 mg twice daily. The primary outcome measure was incidence of VTE within 60 days postoperatively. Demographic characteristics and other risk factors for VTE were also recorded, as well as any postoperative complications. Among the 1,276 knee arthroscopies, there were 26 VTE events (2.0%), including 23 with deep vein thrombosis (DVT), two pulmonary emboli (PE), and one patient with both DVT and PE. There were no deaths or complications requiring hospitalization or reoperation. The VTE diagnosis occurred at, on average, 9 days postoperatively. Patients in the high-risk group treated with enoxaparin had a lower VTE incidence (1.49%) than those instructed to take aspirin (2.0%); = 0.75. Those undergoing an anterior cruciate ligament (ACL) reconstruction had the highest VTE incidence (2.87%). This study found that a chemoprophylaxis protocol with preferential use of aspirin or low-molecular weight heparin based on risk factors reduced the VTE incidence below to 2.0%, which is lower than most historical controls.
在未接受化学预防的膝关节镜检查患者中，有报道称症状性静脉血栓栓塞症（VTE）的发生率高达 10.9%。本研究旨在评估膝关节镜检查患者中化学预防方案的有效性。对一项新的机构性 VTE 预防方案中前瞻性入组患者的回顾性研究，确定了 5 年内所有接受膝关节镜检查的患者。该基于风险的化学预防方案基于 Caprini 模型制定：有高风险的患者接受依诺肝素 40mg 每日预防 3 周，而其余患者则被指示服用阿司匹林 325mg 每日 2 次。主要观察指标为术后 60 天内 VTE 的发生率。还记录了人口统计学特征和其他 VTE 危险因素，以及任何术后并发症。在 1276 例膝关节镜检查中，有 26 例 VTE 事件（2.0%），包括 23 例深静脉血栓形成（DVT）、2 例肺栓塞（PE）和 1 例 DVT 和 PE 并存的患者。无死亡或需要住院或再次手术的并发症。VTE 的诊断发生在术后平均 9 天。接受依诺肝素治疗的高危组患者的 VTE 发生率（1.49%）低于接受阿司匹林治疗的患者（2.0%）； = 0.75。接受前交叉韧带（ACL）重建的患者 VTE 发生率最高（2.87%）。本研究发现，基于危险因素，优先使用阿司匹林或低分子肝素的化学预防方案可将 VTE 发生率降低至 2.0%以下，低于大多数历史对照。
