Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Department of Orthopaedic Surgery, University of California Los Angeles, Santa Monica, California.
J Arthroplasty. 2022 Dec;37(12):2444-2448.e1. doi: 10.1016/j.arth.2022.07.006. Epub 2022 Jul 16.
Aspirin as a venous thromboembolism (VTE) prophylactic agent has been shown to have antistaphylococcal and antibiofilm roles. Optimal acetylsalicylic acid (ASA) dosage would facilitate antimicrobial effects while avoiding over-aggressive inhibition of platelet antimicrobial function. Our purpose was to determine the periprosthetic joint infection (PJI) rate after total joint arthroplasty in patients receiving low-dose ASA (81 mg twice a day), in comparison to high-dose ASA (325 mg twice a day).
We conducted a retrospective cohort study between 2008 and 2020. Eligible patients were older than 18 years, underwent primary total joint arthroplasty, both total knee arthroplasty and total hip arthroplasty, had a minimum 30-day follow-up, and received a full course ASA as VTE prophylaxis. Patients' records were reviewed for PJI, according to Musculoskeletal Infection Society criteria. Patients were excluded if they underwent revision arthroplasty, had a history of coagulopathy, or had an ASA regimen that was not completed. In total 15,825 patients were identified, 8,761 patients received low-dose ASA and 7,064 received high-dose ASA.
The high-dose cohort had a higher PJI rate (0.35 versus 0.10%, P = .001). This relationship was maintained when comparing subgroups comprising total knee arthroplasty (0.32 versus 0.06%, P = .019) or total hip arthroplasty (0.38 versus 0.14%, P = .035) and accounting for potentially confounding demographic and surgical variables (odds ratio = 2.59, 95% CI = 1.15-6.40, P = .028).
Comparing low-dose to high-dose ASA as a VTE prophylactic agent, low-dose ASA had a lower PJI rate. This may be attributable to a balance of anti-infective properties of ASA and antiplatelet effects.
阿司匹林作为一种静脉血栓栓塞症（VTE）预防剂，已被证明具有抗葡萄球菌和抗生物膜作用。最佳乙酰水杨酸（ASA）剂量将有助于发挥抗菌作用，同时避免过度抑制血小板的抗菌功能。我们的目的是确定接受低剂量 ASA（每天 2 次 81 毫克）的全关节置换术后患者的假体周围关节感染（PJI）发生率，与高剂量 ASA（每天 2 次 325 毫克）相比。
我们进行了一项回顾性队列研究，时间为 2008 年至 2020 年。符合条件的患者年龄大于 18 岁，接受初次全关节置换术，包括全膝关节置换术和全髋关节置换术，随访时间至少 30 天，并接受完整疗程的 ASA 作为 VTE 预防剂。根据肌肉骨骼感染学会的标准，对患者的记录进行了 PJI 检查。如果患者接受了翻修手术、有凝血功能障碍病史或 ASA 方案未完成，则将其排除在外。共确定了 15825 名患者，8761 名患者接受低剂量 ASA，7064 名患者接受高剂量 ASA。
高剂量组的 PJI 发生率更高（0.35%比 0.10%，P=0.001）。当比较包括全膝关节置换术（0.32%比 0.06%，P=0.019）或全髋关节置换术（0.38%比 0.14%，P=0.035）的亚组时，以及在考虑潜在混杂的人口统计学和手术变量时，这种关系仍然存在（比值比=2.59，95%置信区间=1.15-6.40，P=0.028）。
与高剂量 ASA 相比，低剂量 ASA 作为 VTE 预防剂的 PJI 发生率较低。这可能归因于 ASA 的抗感染特性和抗血小板作用之间的平衡。
