Medical University of South Carolina, Charleston, South Carolina.
Emory University, Atlanta, Georgia, U.S.A.
Arthroscopy. 2021 Mar;37(3):924-931. doi: 10.1016/j.arthro.2020.10.025. Epub 2020 Oct 22.
To use the Truven MarketScan database to (1) report the incidence of venous thromboembolism (VTE), including deep vein thromboses (DVTs) and pulmonary embolism (PE), in patients undergoing simple knee arthroscopy and anterior cruciate ligament (ACL) reconstruction, and (2) evaluate combined oral contraceptive (COCP) use as a potential risk factor for VTE in patients undergoing knee arthroscopy.
All female patients between the ages of 16 and 40 years undergoing knee arthroscopy and ACL reconstruction between 2010 and 2015 were identified in the MarketScan database. Patients were stratified by whether they had a documented pharmaceutical claim for COCP therapy, and the primary outcome was the risk of DVT and or PE within 90 postoperative days.
In total, 64,165 patients were identified for inclusion. While the overall incidence of VTE was low, patients taking COCPs had an increased risk of a DVT or PE compared with those not on COCPs (odds ratio [OR] 2.1, P < .001). When patients were analyzed by procedural subgroup (ACL reconstruction and simple knee arthroscopy), similar results held true. Furthermore, smoking and obesity had a synergistic effect when combined with COCPs use on the risk of VTE. Specifically, 3.1% of patients with obesity on COCPs (OR 3.1, P < .001) and 4.0% of smokers on COCPs (OR 4.3, P < .001) developed a postoperative VTE.
This study demonstrates that COCP use is associated with an increased risk for a symptomatic DVT or PE (1.70% and 0.27%, respectively) after knee arthroscopy and an increased risk for DVT, but not PE (1.80% and 0.23%, respectively), after ACL reconstruction. In addition, patients with multiple risk factors present such as tobacco use, obesity, and COCP use had odds ratios greater than the sum of the individual risk factors alone.
level III prognostic cohort study.
利用 Truven MarketScan 数据库（1）报告接受单纯膝关节镜检查和前交叉韧带（ACL）重建的患者中静脉血栓栓塞症（VTE）（包括深静脉血栓形成（DVT）和肺栓塞（PE））的发生率，（2）评估口服避孕药（COCP）的使用是否为膝关节镜检查患者 VTE 的潜在危险因素。
在 MarketScan 数据库中确定 2010 年至 2015 年间年龄在 16 至 40 岁之间接受膝关节镜检查和 ACL 重建的所有女性患者。根据是否有 COCP 治疗的药物索赔记录对患者进行分层，主要结果是术后 90 天内 DVT 和或 PE 的风险。
共确定 64165 例患者纳入研究。虽然 VTE 的总体发生率较低，但与未服用 COCP 的患者相比，服用 COCP 的患者发生 DVT 或 PE 的风险增加（优势比 [OR] 2.1，P <.001）。当按手术亚组（ACL 重建和单纯膝关节镜检查）分析患者时，结果相似。此外，吸烟和肥胖与 COCP 联合使用对 VTE 风险有协同作用。具体而言，3.1%的肥胖 COCP 患者（OR 3.1，P <.001）和 4.0%的吸烟 COCP 患者（OR 4.3，P <.001）发生术后 VTE。
这项研究表明，COCP 的使用与膝关节镜检查后症状性 DVT 或 PE（分别为 1.70%和 0.27%）以及 ACL 重建后 DVT （1.80%和 0.23%）的风险增加相关，但不与 PE 相关。此外，存在多种危险因素的患者（如吸烟、肥胖和 COCP 使用）的优势比大于单个危险因素的总和。
III 级预后队列研究。
