Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
J Arthroplasty. 2021 Jul;36(7):2359-2363. doi: 10.1016/j.arth.2021.02.007. Epub 2021 Feb 6.
Consensus on whether low-dose (81 mg) or regular-dose (325 mg) aspirin (ASA) is more effective for venous thromboembolism (VTE) chemoprophylaxis in primary total joint arthroplasties (TJAs) is not reached. The goal of this study is to evaluate the efficacy of low-dose and regular-dose ASA for VTE chemoprophylaxis in primary total hip arthroplasties and total knee arthroplasties.
We retrospectively identified 3512 primary TJAs (2344 total hip arthroplasties and 1168 total knee arthroplasties) with ASA used as VTE chemoprophylaxis between 2000 and 2019. Patients received ASA twice daily for 4-6 weeks after surgery with 961 (27%) receiving low-dose ASA and 2551 (73%) receiving regular-dose ASA. The primary endpoint was 90-day incidence of symptomatic VTEs. Secondary outcomes were gastrointestinal (GI) bleeding events and mortality. The mean age at index TJA was 66 years, 54% were female, and mean body mass index was 31 kg/m. The mean Charlson Comorbidity Index was 3.5. Mean follow-up was 3 years.
There was no difference in 90-day incidence of symptomatic VTEs between low-dose and regular-dose ASA (0% vs 0.1%, respectively; P = .79). There were no GI bleeding events in either group. There was no difference in 90-day mortality between low-dose and regular-dose ASA (0.3% vs 0.1%, respectively; P = .24).
In 3512 primary TJA patients treated with ASA, we found a cumulative incidence of VTE <1% at 90 days. Although this study is underpowered, it appears that twice daily low-dose ASA was equally effective to twice daily regular-dose ASA for VTE chemoprophylaxis, with no difference in risk of GI bleeds or mortality.
III, retrospective cohort study.
对于初次全关节置换术（TJA）中静脉血栓栓塞症（VTE）的化学预防，低剂量（81mg）与常规剂量（325mg）阿司匹林（ASA）何者更有效尚未达成共识。本研究旨在评估低剂量与常规剂量 ASA 用于初次全髋关节置换术和全膝关节置换术 VTE 化学预防的疗效。
我们回顾性确定了 2000 年至 2019 年间使用 ASA 作为 VTE 化学预防的 3512 例初次 TJA（2344 例全髋关节置换术和 1168 例全膝关节置换术）。术后患者每日接受 ASA 治疗 2 次，持续 4-6 周，其中 961 例（27%）接受低剂量 ASA，2551 例（73%）接受常规剂量 ASA。主要终点为 90 天内有症状的 VTE 发生率。次要结局为胃肠道（GI）出血事件和死亡率。指数 TJA 时的平均年龄为 66 岁，54%为女性，平均体重指数为 31kg/m。平均 Charlson 合并症指数为 3.5。平均随访 3 年。
低剂量与常规剂量 ASA 的 90 天内有症状 VTE 发生率无差异（分别为 0%和 0.1%；P=0.79）。两组均无 GI 出血事件。低剂量与常规剂量 ASA 的 90 天死亡率无差异（分别为 0.3%和 0.1%；P=0.24）。
在接受 ASA 治疗的 3512 例初次 TJA 患者中，我们发现 90 天内 VTE 的累积发生率<1%。尽管本研究的效力不足，但每日 2 次低剂量 ASA 似乎与每日 2 次常规剂量 ASA 一样有效预防 VTE，在 GI 出血或死亡率方面无差异。
III 级，回顾性队列研究。
