School of Pharmacy, University of Queensland, Brisbane, Australia.
Pharmacy Department, Princess Alexandra Hospital, Brisbane, Australia.
Drugs. 2020 Dec;80(18):1889-1899. doi: 10.1007/s40265-020-01413-w.
Total hip arthroplasties (THA) and total knee arthroplasties (TKA) confer one of the highest risks for developing venous thromboembolism (VTE) and pharmacological prophylaxis is imperative to help mitigate the risks. Aspirin is the most cost-effective medication for VTE prophylaxis, and its use post-THA/TKA has grown in popularity. Aspirin resistance is categorised as clinical or laboratory resistance with obesity, advancing age, diabetes mellitus, dyslipidaemia and inflammatory diseases identified as risk factors for aspirin resistance. Treatment failure due to aspirin resistance has been reported in cardiovascular and cerebrovascular disease leading to increased rates of mortality and re-embolisation. However, aspirin resistance in patients undergoing a THA/TKA has not been described, nor has there been investigation into the incidence rates or clinical outcomes. The aim of this narrative review is to appraise the concept of aspirin resistance in the context of aspirin use for VTE prophylaxis after THA/TKA surgeries. This is important to investigate as the risk factors for aspirin resistance, including obesity, advancing age, diabetes mellitus, dyslipidaemia and inflammatory diseases, are also risk factors for THA/TKA and risk factors for VTE. The presence of aspirin resistance in patients undergoing orthopaedic surgery may place patients at greater risk of thrombotic events if aspirin is prescribed for VTE prophylaxis. This could further increase the risk of complications associated with VTE and potential long-term consequences such as post-thrombotic syndrome. Future research is required to explore and quantify the rates of aspirin resistance and the clinical outcomes in orthopaedic patients; especially in those patients with these overlapping risk factors for THA/TKA, VTE and aspirin resistance.
全髋关节置换术（THA）和全膝关节置换术（TKA）发生静脉血栓栓塞症（VTE）的风险最高，因此必须进行药物预防。阿司匹林是预防 VTE 最具成本效益的药物，其在 THA/TKA 后的应用越来越普及。阿司匹林抵抗分为临床抵抗或实验室抵抗，肥胖、年龄增长、糖尿病、血脂异常和炎症性疾病被认为是阿司匹林抵抗的危险因素。由于阿司匹林抵抗导致心血管和脑血管疾病治疗失败的报道导致死亡率和再栓塞率增加。然而，尚未描述接受 THA/TKA 的患者的阿司匹林抵抗情况，也没有调查其发生率或临床结果。本叙述性综述的目的是评估在 THA/TKA 手术后使用阿司匹林预防 VTE 时阿司匹林抵抗的概念。这一点很重要，因为阿司匹林抵抗的危险因素，包括肥胖、年龄增长、糖尿病、血脂异常和炎症性疾病，也是 THA/TKA 的危险因素和 VTE 的危险因素。如果为预防 VTE 而开具阿司匹林，正在接受骨科手术的患者可能存在更大的血栓形成事件风险。这可能会进一步增加与 VTE 相关的并发症风险以及潜在的长期后果，如血栓后综合征。需要进一步的研究来探索和量化骨科患者的阿司匹林抵抗率和临床结果；特别是在那些具有 THA/TKA、VTE 和阿司匹林抵抗重叠危险因素的患者中。
