Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
J Knee Surg. 2022 Jul;35(8):909-915. doi: 10.1055/s-0040-1721092. Epub 2020 Nov 25.
Venous thromboembolism (VTE) is a rare, but serious complication following total knee arthroplasty (TKA). Current VTE guidelines recommend pharmacologic agents with or without intermittent pneumatic compression devices (IPCDs). At our institution, both 81-mg aspirin (ASA) twice a day (BID) and portable IPCDs were previously prescribed to TKA patients at standard risk for VTE, but the IPCDs were discontinued and patients were treated with ASA alone going forward. The aim of this study is to determine if discontinued use of outpatient IPCDs is safe and does not increase the rate of VTE or any other related complications in patients following TKA. A retrospective review of 2,219 consecutive TKA cases was conducted, identifying patients with VTE, bleeding complications, infection, and mortality within 90 days postoperatively. Patients were divided into two cohorts. Patients in cohort one received outpatient IPCDs for a period of 14 days (control), while those in cohort two did not (ASA alone). All study patients received inpatient IPCDs and were maintained on 81-mg ASA BID for 28 days. A posthoc power analysis was performed using a noninferiority margin of 0.25 (α = 0.05; power = 80%), which showed that our sample size was fully powered for noninferiority for our reported deep vein thrombosis (DVT) rates, but not for pulmonary embolism (PE) rates. A total of 867 controls and 1,352 patients treated with ASA alone were identified. Only two control patients were diagnosed with a PE (0.23%), while one patient in the ASA alone group had DVT (0.07%). There was no statistical difference between these rates ( = 0.33). Furthermore, no differences were found in bleeding complications ( = 0.12), infection ( = 0.97), or 90-day mortality rates ( = 0.42) between both groups. The discontinued use of outpatient portable IPCDs is noninferior to outpatient IPCD use for DVT prophylaxis. Our findings suggest that this protocol change may be safe and does not increase the rate of VTE in standard risk patients undergoing TKA while using 81-mg ASA BID.
静脉血栓栓塞症（VTE）是全膝关节置换术后一种罕见但严重的并发症。目前的 VTE 指南建议使用药物治疗，或在药物治疗的基础上联合间歇性气动压迫装置（IPC）。在我们的机构，对于接受全膝关节置换术且 VTE 风险处于标准范围的患者，我们同时开具 81mg 阿司匹林（ASA），每天两次（BID）和便携式 IPCD。但是，我们停止了对患者使用便携式 IPCD，并让他们继续使用 ASA 进行治疗。本研究旨在确定停用门诊便携式 IPCD 是否安全，且不会增加全膝关节置换术后患者的 VTE 发生率或任何其他相关并发症的发生率。我们对 2219 例连续全膝关节置换术病例进行了回顾性分析，确定了术后 90 天内 VTE、出血并发症、感染和死亡率的患者。患者被分为两组。一组患者在门诊使用 IPCD 治疗 14 天（对照组），而另一组患者未使用 IPCD（仅使用 ASA）。所有研究患者均接受住院 IPCD 治疗，并使用 81mg ASA BID 治疗 28 天。我们使用非劣效性边界 0.25（α = 0.05；效能 = 80%）进行了事后功效分析，结果显示，我们的样本量足以对报告的深静脉血栓形成（DVT）发生率进行非劣效性检验，但不足以对肺栓塞（PE）发生率进行非劣效性检验。共确定了 867 例对照组和 1352 例仅使用 ASA 治疗的患者。对照组中仅有 2 例患者被诊断为 PE（0.23%），而 ASA 组中有 1 例患者发生 DVT（0.07%）。两组之间的发生率无统计学差异（ = 0.33）。此外，两组之间在出血并发症（ = 0.12）、感染（ = 0.97）或 90 天死亡率（ = 0.42）方面均无差异。停用门诊便携式 IPCD 与门诊使用 IPCD 预防 DVT 效果相当。我们的研究结果表明，对于接受全膝关节置换术且使用 81mg ASA BID 治疗的标准风险患者，这种方案改变可能是安全的，并且不会增加 VTE 的发生率。
