Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California.
J Bone Joint Surg Am. 2022 Jan 19;104(2):107-114. doi: 10.2106/JBJS.21.00528.
Patient-reported allergies to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) may preclude certain patients from receiving aspirin as venous thromboembolism (VTE) prophylaxis after total joint arthroplasty (TJA). The purpose of the study was to (1) determine whether the use of non-aspirin agents due to a self-reported aspirin or NSAID allergy was associated with a higher incidence of VTE and (2) determine the rate of true allergic reactions in patients who reported an allergy but still received aspirin.
Prospectively collected data from 45,171 patients who underwent primary TJA between 2000 and 2019 were reviewed. Patients who reported an allergy to aspirin or NSAIDs were identified (n = 823). Using a validated VTE risk calculator, each patient was assigned a risk score based on 26 comorbidities. Bleeding complications, VTEs that occurred within 90 days postoperatively, and allergic reactions were collected as end points. Multivariable logistic regression was performed to determine the factors associated with VTE.
The overall incidence of aspirin or NSAID allergy was 1.8%. Only 80 of 267 patients (30%) reported an allergy to only aspirin and still received aspirin. Compared with patients who received aspirin without a history of allergy (n = 17,648), patients who received non-aspirin thromboprophylaxis due to allergy (n = 383) had a higher incidence of VTE (2.87% versus 0.24%, p < 0.001). On multivariable regression, these patients had an 8-fold increase in VTE risk (adjusted odds ratio, 7.94; 95% confidence interval, 2.86 to 22.07; p < 0.001). The incidence of true allergic reactions to aspirin among those with a reported allergy was 1.8% (number needed to harm = 55). No patients developed anaphylaxis or severe hypersensitivity reactions.
Patients with a self-reported allergy to aspirin or NSAIDs were at a significantly increased risk for VTE if they received non-aspirin thromboprophylaxis agents following TJA. Future research should evaluate the usefulness of preoperative allergy testing when selecting a VTE prophylactic agent in patients with self-reported allergies.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
患者自述对阿司匹林或非甾体抗炎药（NSAIDs）过敏可能会使某些患者在接受全关节置换术后（TJA）时无法使用阿司匹林进行静脉血栓栓塞（VTE）预防。本研究的目的是：（1）确定因自述对阿司匹林或 NSAIDs 过敏而使用非阿司匹林药物是否与更高的 VTE 发生率相关；（2）确定报告过敏但仍接受阿司匹林治疗的患者中真正过敏反应的发生率。
对 2000 年至 2019 年间接受初次 TJA 的 45171 例患者的前瞻性收集数据进行了回顾性分析。确定报告对阿司匹林或 NSAIDs 过敏的患者（n=823）。使用经过验证的 VTE 风险计算器，根据 26 种合并症为每位患者分配风险评分。收集出血并发症、术后 90 天内发生的 VTE 和过敏反应作为终点。采用多变量逻辑回归确定与 VTE 相关的因素。
总体阿司匹林或 NSAID 过敏发生率为 1.8%。在 267 例仅报告对阿司匹林过敏的患者中，仅有 80 例（30%）仍接受阿司匹林治疗。与无过敏史接受阿司匹林治疗的患者（n=17648）相比，因过敏而接受非阿司匹林血栓预防治疗的患者（n=383）VTE 发生率更高（2.87%比 0.24%，p<0.001）。多变量回归分析显示，这些患者 VTE 风险增加 8 倍（调整优势比，7.94；95%置信区间，2.86 至 22.07；p<0.001）。报告过敏的患者中，对阿司匹林发生真正过敏反应的发生率为 1.8%（需治疗人数=55）。无患者发生过敏反应或严重超敏反应。
在 TJA 后接受非阿司匹林血栓预防药物治疗的患者，自述对阿司匹林或 NSAIDs 过敏，其 VTE 风险显著增加。未来的研究应评估在有自述过敏史的患者中选择 VTE 预防药物时术前过敏测试的有用性。
治疗性 III 级。有关证据水平的完整描述，请参阅作者说明。
