Department of Orthopaedics, Peking Union Medical College Hospital, CAMS & PUMC, Beijing, China.
Orthop Surg. 2021 Feb;13(1):260-266. doi: 10.1111/os.12926. Epub 2021 Jan 15.
Venous thromboembolism (VTE) is a significant concern post total joint arthroplasty (TJA). However, the optimal prevention method of VTE remains controversial at present. This study aims to evaluate a risk-stratified VTE prophylaxis protocol for patients undergoing TJA.
A total of 891 TJA patients from January 2011 to November 2019 were retrospectively investigated. The study was divided into two cohorts. In cohort 1, 410 patients (250 females and 160 males, mean age 64.32 years) were treated with an aggressive VTE chemoprophylaxis protocol. In cohort 2, 481 patients were treated with a risk-stratified protocol that utilized low molecular weight heparins (LMWH) and sequential aspirin (ASA) for standard-risk patients (a total of 288 containing 177 females and 111 males, mean age 65.4 years), and targeted anticoagulation for high-risk patients (a total of 193 containing 121 females and 72 males, mean age 66.8 years). The patients were followed up at 2-4 weeks for an initial visit and at 6-10 weeks for a subsequent visit after surgery. A chart review of all patient medical records was performed to record the demographics, comorbidities, deep vein thrombosis, pulmonary embolus, superficial infection, deep infection, bleeding complications, and 90-day readmissions.
The VTE rate was 1.71% (7/410) in cohort 1 and 1.46% (7/481) in cohort 2 respectively. For cohort 2, the VTE rate was 2.07% (4/193) in high-risk group and 1.04% (3/288) in standard-risk group. The readmission rate was 2.44% (10/410) in cohort 1 and 2.08% (10/481) in cohort 2. For cohort 2, the readmission rate was 2.07% (4/193) in high-risk group and 2.08% (6/288) in standard-risk group. The reasons for readmission were as follows: infection, 1.3% (5/410) in cohort 1 and 1.3% (6/481) in cohort 2; wound or bleeding complications, 0.48% (2/410) in cohort 1 and 0.2% (1/481) in cohort 2; trauma, 0.2% (1/410) in cohort 1 and 0.2% (1/481) in cohort 2; VTE, 0.2% (1/410) in cohort 1 and 0.2% (1/481) in cohort 2; others, 0.2% (1/410) in cohort 1 and 0.6% (3/481) in cohort 2. There was a decrease in VTE events and readmissions in the risk-stratified cohort, although this did not reach statistical significance. However, it was found that there was a significant reduction in costs (P < 0.001) with the use of LMWH/ASA, when compared with aggressive anticoagulation agents in the risk-stratified cohort.
The use of LMWH/ASA in a risk-stratified TJA population is a safe and cost-effective method of VTE prophylaxis.
静脉血栓栓塞症（VTE）是全关节置换术后的一个重大问题。然而，目前最佳的 VTE 预防方法仍存在争议。本研究旨在评估一种用于全关节置换术患者的风险分层 VTE 预防方案。
回顾性调查了 2011 年 1 月至 2019 年 11 月期间的 891 例全关节置换术患者。该研究分为两个队列。在队列 1 中，410 例患者（250 名女性和 160 名男性，平均年龄 64.32 岁）接受了积极的 VTE 化学预防方案治疗。在队列 2 中，481 例患者接受了风险分层方案治疗，该方案对标准风险患者（共 288 例，其中 177 名女性和 111 名男性，平均年龄 65.4 岁）使用低分子肝素（LMWH）和序贯阿司匹林（ASA），对高风险患者（共 193 例，其中 121 名女性和 72 名男性，平均年龄 66.8 岁）使用靶向抗凝治疗。术后 2-4 周和 6-10 周对所有患者进行了初始就诊和后续就诊的随访。对所有患者的病历进行了图表回顾，记录了人口统计学、合并症、深静脉血栓形成、肺栓塞、浅表感染、深部感染、出血并发症和 90 天再入院情况。
队列 1 的 VTE 发生率为 1.71%（7/410），队列 2 的 VTE 发生率为 1.46%（7/481）。对于队列 2，高危组的 VTE 发生率为 2.07%（4/193），标准风险组的 VTE 发生率为 1.04%（3/288）。队列 1 的再入院率为 2.44%（10/410），队列 2 的再入院率为 2.08%（10/481）。对于队列 2，高危组的再入院率为 2.07%（4/193），标准风险组的再入院率为 2.08%（6/288）。再入院的原因如下：感染，1.3%（5/410）在队列 1 中和 1.3%（6/481）在队列 2 中；伤口或出血并发症，0.48%（2/410）在队列 1 中和 0.2%（1/481）在队列 2 中；创伤，0.2%（1/410）在队列 1 中和 0.2%（1/481）在队列 2 中；VTE，0.2%（1/410）在队列 1 中和 0.2%（1/481）在队列 2 中；其他，0.2%（1/410）在队列 1 中和 0.6%（3/481）在队列 2 中。在风险分层队列中，VTE 事件和再入院率有所下降，尽管这并未达到统计学意义。然而，与风险分层队列中使用的积极抗凝药物相比，LMWH/ASA 的使用显著降低了成本（P<0.001）。
在风险分层的全关节置换术患者中使用 LMWH/ASA 是一种安全且具有成本效益的 VTE 预防方法。
