Department of Pharmacy, University of Huddersfield, Huddersfield, UK.
School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, Australia.
Int J Clin Pharm. 2021 Jun;43(3):621-628. doi: 10.1007/s11096-020-01173-3. Epub 2020 Oct 18.
Background Increasing evidence for the use of the aspirin in patients undergoing an orthopaedic surgery for venous thromboembolism prophylaxis has led to a change in the national guidelines substituting anticoagulants with aspirin. Little is known about the impact of such substitution on real-world outcomes from clinical practice. Objective The study was designed to examine clinical outcomes associated with the use of aspirin and apixaban. Setting Two large-scale general hospitals in West Yorkshire region of England. Method A 1-year observational study among adults who underwent elective knee replacements and received venous thromboembolism prophylaxis within the first 14 days post replacements. Main outcome measure The incidence of postoperative venous thromboembolism, leaking wounds during the hospital stay, and 30-day any readmission for the two drugs. Results A total of 420 patients were included. There was a significant drop in apixaban prescribing (from 80.37 to 10.51%) and increase in aspirin use (from 19.02 to 81.71%) after the implementation of the revised guidelines. There were 52 (12.38%) cases of leaking wound, 16 (3.81%) cases of postoperative venous thromboembolism, 45 (10.71%) cases of 30-day readmission and no case of 30-day major bleeding. The leaking wounds and 30-day readmissions were almost twice more frequent in obese compared to non-obese patients. Multivariate logistic regression found an increased risk of leaking wound with apixaban and postoperative venous thromboembolism and 30-day readmission with aspirin use but the differences were not statistically significant. Conclusion The results suggest aspirin to be as effective as apixaban in preventing venous thromboembolism and readmission. Apixaban usage decreased with a corresponding increase in Aspirin use. The impact of obesity and length of hospital stay need further investigations.
越来越多的证据表明，在接受骨科手术预防静脉血栓栓塞的患者中使用阿司匹林，可以改变国家指南，用阿司匹林替代抗凝剂。但对于这种替代方案对临床实践实际结果的影响知之甚少。目的：本研究旨在检查与使用阿司匹林和阿哌沙班相关的临床结果。设置：英格兰西约克郡地区的两家大型综合医院。方法：对接受择期膝关节置换术并在置换后 14 天内接受静脉血栓栓塞预防治疗的成年人进行为期 1 年的观察性研究。主要观察指标：两种药物的术后静脉血栓栓塞、住院期间漏伤口和 30 天内任何再入院的发生率。结果：共纳入 420 例患者。在实施修订后的指南后，阿哌沙班的处方量显著下降（从 80.37%降至 10.51%），而阿司匹林的使用量显著增加（从 19.02%增至 81.71%）。有 52 例（12.38%）漏伤口，16 例（3.81%）术后静脉血栓栓塞，45 例（10.71%）30 天再入院，无 30 天大出血病例。与非肥胖患者相比，肥胖患者的漏伤口和 30 天再入院几乎增加了一倍。多变量逻辑回归发现，阿哌沙班与漏伤口和术后静脉血栓栓塞，以及阿司匹林使用与 30 天再入院风险增加相关，但差异无统计学意义。结论：结果表明，阿司匹林在预防静脉血栓栓塞和再入院方面与阿哌沙班同样有效。阿哌沙班的使用减少，而阿司匹林的使用相应增加。肥胖和住院时间的影响需要进一步调查。
