Christian Robert A, Lander Sarah T, Bonazza Nicholas A, Reinke Emily K, Lentz Trevor A, Dodds Julie A, Mulcahey Mary K, Ford Anne C, Wittstein Jocelyn R
Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A.
Duke Clinical Research Institute, Duke University, Durham, North Carolina, U.S.A.
Arthrosc Sports Med Rehabil. 2022 Jan 26;4(2):e679-e685. doi: 10.1016/j.asmr.2021.12.010. eCollection 2022 Apr.
To evaluate the venous thromboembolism (VTE) prophylaxis practices of surgeons performing anterior cruciate ligament reconstruction (ACLR) in female patients using hormonal contraceptives.
Our research team designed an investigational survey using branching logic that was made available to the AANA membership. The survey was designed to identify clinical decision making regarding VTE prophylaxis after ACLR in patients without risk factors for VTE, the counseling of patients about VTE risk associated with hormonal contraceptives, and the use of VTE prophylaxis after ACLR in patients taking hormonal contraceptives.
Ninety-four respondents completed the survey. Eighty-nine respondents identified their gender (63% male and 37% female respondents). Respondents reported performing the following number of ACLRs annually: more than 50 (40%), 30 to 50 (29%), 15 to 30 (29%), and fewer than 15 (2%). Of the respondents, 62 (67%) reported that VTE developed after ACLR in their patients (male patients only, 32%; female patients only, 24%; and both male and female patients, 34%). Sixty-seven percent used chemoprophylaxis after ACLR. Surgeons who asked about hormonal contraceptive use were more likely to be women ( = .01; odds ratio [OR], 4.2). Surgeons who changed their VTE prophylaxis plan as a result of asking about hormonal contraceptive use were more likely to be women ( = .02; OR, 2.8). Surgeons who asked about hormonal contraceptive use were more likely to have female patients with VTE after ACLR ( = .03; OR, 2.9). Surgeons who changed their VTE prophylaxis plan as a result of asking about hormonal contraceptive use were more likely to have female patients with VTE after ACLR ( = .001; OR, 4.6).
There is no standard of care for VTE prophylaxis after ACLR. A surgeon's own gender and prior clinical experience with VTE after ACLR may influence his or her likelihood to consider a patient's hormonal contraceptive use regarding VTE risk after ACLR.
The use of hormonal contraception is a risk factor for VTE in female patients undergoing ACLR. It is important to identify current practice patterns and the need for a standard of care.
评估在使用激素避孕药的女性患者中进行前交叉韧带重建（ACLR）的外科医生对静脉血栓栓塞（VTE）的预防措施。
我们的研究团队设计了一项使用分支逻辑的调查研究，并将其提供给美国麻醉护士协会（AANA）的会员。该调查旨在确定在无VTE风险因素的患者进行ACLR后关于VTE预防的临床决策、就激素避孕药相关的VTE风险对患者进行的咨询，以及在服用激素避孕药的患者进行ACLR后VTE预防措施的使用情况。
94名受访者完成了调查。89名受访者确定了自己的性别（63%为男性受访者，37%为女性受访者）。受访者报告每年进行ACLR的数量如下：超过50例（40%）、30至50例（29%）、15至30例（29%）以及少于15例（2%）。在受访者中，62名（67%）报告其患者在ACLR后发生了VTE（仅男性患者，32%；仅女性患者，24%；男性和女性患者均有，34%）。67%的人在ACLR后使用了化学预防措施。询问激素避孕药使用情况的外科医生更可能是女性（P = 0.01；优势比[OR]，4.2）。因询问激素避孕药使用情况而改变VTE预防计划的外科医生更可能是女性（P = 0.02；OR，2.8）。询问激素避孕药使用情况的外科医生更可能有ACLR后发生VTE的女性患者（P = 0.03；OR，2.9）。因询问激素避孕药使用情况而改变VTE预防计划的外科医生更可能有ACLR后发生VTE的女性患者（P = 0.001；OR，4.6）。
ACLR后VTE预防没有护理标准。外科医生自身的性别以及ACLR后VTE的既往临床经验可能会影响其在ACLR后考虑患者激素避孕药使用与VTE风险相关情况的可能性。
激素避孕药的使用是接受ACLR的女性患者发生VTE的一个风险因素。确定当前的实践模式以及护理标准的必要性很重要。
