Dietz Matthew J, Moushmoush Obadah, Frye Benjamin M, Lindsey Brock A, Murphy T Ryan, Klein Adam E
From the Department of Orthopaedics, West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center, Morgantown, WV (Dietz, Frye, Lindsey, Murphy, and Klein), and MedStar Georgetown University Hospital/Washington Hospital Center, Washington, DC (Moushmoush).
J Am Acad Orthop Surg. 2022 Oct 15;30(20):e1319-e1326. doi: 10.5435/JAAOS-D-21-01063. Epub 2022 Jun 29.
Aspirin, as a routine venous thromboembolism (VTE) prophylaxis, is approved along with pneumatic compression pumps by the American College of Chest Physicians. We assessed compliance of aspirin and pump use after total joint arthroplasty.
A randomized trial of aspirin alone or aspirin/mobile compression pumps after total joint arthroplasty was performed. Aspirin and pump compliance, VTE events, and satisfaction with pump use were collected. Compliance was assessed through an internal device monitor and drug log book. Patients were also contacted 90 days postoperatively for reported symptomatic VTEs.
Each group had 40 patients and greater than 94% compliance with aspirin use, with no difference between groups (P = 0.55). Overall pump compliance during the first 14 days after hospital discharge was 51% (SD ± 33), which was significantly worse than aspirin compliance at 99% (SD ± 4.1) (P < 0.0001). Only 10 patients were compliant (>20 hr/d) with recommended pump use throughout the entire recommended period. There was no notable association between aspirin compliance and VTE within 90 days. There was no notable association between pump compliance and VTE at 90 days. However, average pump use compliance was 20% in patients with VTE and 54% in patients without VTE within 90 days. With the numbers available in this compliance study, there was no significant difference (P = 0.11).
Aspirin compliance was notably greater than pump compliance. In this study, we found that pump compliance was not associated with lower VTE risk. In fact, no increased risk was recognized in patients with an average pump usage of >50%. Further study is warranted to define the duration of pump use required for clinical significance. The recommended use of compression pumps should continue to be examined.
阿司匹林作为常规静脉血栓栓塞症（VTE）预防药物，已被美国胸科医师学会与气动压缩泵一同批准使用。我们评估了全关节置换术后阿司匹林和泵的使用依从性。
进行了一项全关节置换术后单独使用阿司匹林或阿司匹林/移动压缩泵的随机试验。收集了阿司匹林和泵的使用依从性、VTE事件以及对泵使用的满意度。通过内置设备监测器和药物日志评估依从性。术后90天还联系患者以了解报告的有症状VTE情况。
每组有40名患者，阿司匹林使用依从性均超过94%，两组之间无差异（P = 0.55）。出院后前14天泵的总体依从性为51%（标准差±33），明显低于阿司匹林的依从性99%（标准差±4.1）（P < 0.0001）。在整个推荐使用期间，只有10名患者符合推荐的泵使用要求（>20小时/天）。90天内阿司匹林依从性与VTE之间无显著关联。90天时泵依从性与VTE之间也无显著关联。然而，90天内发生VTE的患者平均泵使用依从性为20%，未发生VTE的患者为54%。基于该依从性研究中的可用数据，无显著差异（P = 0.11）。
阿司匹林的依从性明显高于泵的依从性。在本研究中，我们发现泵的依从性与较低的VTE风险无关。事实上，平均泵使用量>50%的患者未发现风险增加。有必要进一步研究以确定泵使用具有临床意义所需的持续时间。压缩泵的推荐使用仍需继续研究。
