Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America; Thrombosis Service, University of Utah Health, Salt Lake City, UT, United States of America.
Thrombosis Service, University of Utah Health, Salt Lake City, UT, United States of America; Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, United States of America; Department of Population Health, University of Utah School of Medicine, Salt Lake City, UT, United States of America.
Thromb Res. 2021 Oct;206:120-127. doi: 10.1016/j.thromres.2021.08.009. Epub 2021 Aug 16.
Venous thromboembolism (VTE) and bleeding events following total knee and hip arthroplasty (TKA/THA) are associated with significant morbidity. Clinical guidelines recommend administration of pharmacologic VTE prophylaxis post-operatively, although controversy exists regarding optimal prophylactic strategies.
We performed a retrospective cohort study in patients who underwent elective TKA/TKA in an academic medical center. Patients were stratified by surgery type (TKA/THA) and VTE risk determined by a novel risk stratification protocol and compared pre- and post-protocol implementation. Patients received warfarin pre-protocol and either aspirin or warfarin post-protocol for VTE prophylaxis. Natural language processing identified VTE events and ICD codes were used to identify bleeding events, with all events validated manually.
A total of 1379 surgeries were included for analysis, 839 TKAs and 540 THAs. Post-protocol implementation, 445 (94.1%) patients following TKA and 294 (97.4%) patients following THA received aspirin for VTE prophylaxis. A significant reduction in bleeding events (hazard ratio [HR] = 0.19, p = 0.048) was observed in low-risk THA patients treated with aspirin (post-protocol) compared patients treated with warfarin (pre-protocol). Bleeding events did not differ significantly between low-risk TKA patients treated with aspirin or warfarin. No significant differences in VTE events were observed following the protocol implementation.
The use of a novel risk stratification system to guide VTE prophylaxis selection between aspirin or warfarin following TKA and THA appears safe and effective. Among low-risk patients, aspirin use was associated with fewer bleeding events following THA, without an observed increase in VTE events.
全膝关节和髋关节置换术（TKA/THA）后静脉血栓栓塞（VTE）和出血事件与显著的发病率相关。临床指南建议术后给予药物性 VTE 预防，但关于最佳预防策略仍存在争议。
我们在一家学术医疗中心对接受择期 TKA/THA 的患者进行了回顾性队列研究。根据手术类型（TKA/THA）对患者进行分层，并通过新的风险分层方案确定 VTE 风险，比较方案实施前后的情况。患者在方案实施前接受华法林治疗，方案实施后接受阿司匹林或华法林预防 VTE。自然语言处理确定 VTE 事件，ICD 代码用于识别出血事件，并通过手动验证所有事件。
共纳入 1379 例手术进行分析，839 例 TKA 和 540 例 THA。方案实施后，445 例（94.1%）TKA 患者和 294 例（97.4%）THA 患者接受阿司匹林预防 VTE。与接受华法林（方案前）治疗的低危 THA 患者相比，接受阿司匹林（方案后）治疗的低危 THA 患者出血事件显著减少（风险比 [HR] = 0.19，p = 0.048）。接受阿司匹林或华法林治疗的低危 TKA 患者之间出血事件无显著差异。方案实施后 VTE 事件无显著差异。
使用新的风险分层系统指导 TKA 和 THA 后阿司匹林或华法林预防 VTE 的选择似乎是安全有效的。在低危患者中，THA 后使用阿司匹林与出血事件减少相关，而 VTE 事件无观察到增加。
