Muscatelli Stefano R, Charters Michael A, Hallstrom Brian R
Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
Department of Orthopaedics, Henry Ford Health System, Detroit, MI, USA.
Arthroplast Today. 2021 Jul 15;10:105-107. doi: 10.1016/j.artd.2021.06.015. eCollection 2021 Aug.
Venous thromboembolism is a well-established complication of total hip and knee arthroplasty and hip fracture surgery. Clinical practice guidelines have been proposed to help clinicians provide prophylaxis against this risk. However, most guidelines reference data that are becoming outdated because of new advances in perioperative protocols. Recent data would suggest that aspirin may be appropriate for most patients after total hip and knee replacement and a more potent chemoprophylaxis for higher risk patients. Low-molecular-weight heparin remains the recommended choice after hip fracture surgery, although there is a paucity of recent literature in this patient population. There are randomized trials currently underway in the arthroplasty population that may guide clinicians in the appropriate choice of chemoprophylaxis. These studies should inform updates to the current clinical practice guidelines.
静脉血栓栓塞是全髋关节置换术、全膝关节置换术和髋部骨折手术公认的并发症。已提出临床实践指南以帮助临床医生预防这种风险。然而，由于围手术期方案的新进展，大多数指南所参考的数据正变得过时。最近的数据表明，阿司匹林可能适用于大多数全髋关节和全膝关节置换术后的患者，对于高危患者则采用更强效的化学预防措施。低分子量肝素仍然是髋部骨折手术后的推荐选择，尽管针对该患者群体的近期文献较少。目前在关节置换人群中正在进行随机试验，这可能会指导临床医生选择合适的化学预防措施。这些研究应为更新当前的临床实践指南提供依据。
