From the Department of Orthopaedic Surgery, George Washington University School of Medicine, Washington, DC (Agarwal, Das, and Campbell), Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Harris and Thakkar), and Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA (Golladay).
J Am Acad Orthop Surg. 2023 Apr 1;31(7):e376-e384. doi: 10.5435/JAAOS-D-22-00708. Epub 2023 Jan 18.
In 2011, the American Academy of Orthopaedic Surgeons released a Clinical Practice Guideline` that recommended routine venous thromboembolism (VTE) prophylaxis after total joint arthroplasty. The purpose of this study was to examine (1) the change in the incidence of 90-day VTE, deep vein thrombosis, and pulmonary embolism, (2) the change in the utilization of antithrombotic agents; and (3) the change in the economic burden associated with VTE after total hip arthroplasty (THA) from 2011 to 2019.
National, administrative claims data from 2011 to 2019 were used to identify patients who underwent primary THA for osteoarthritis. Exclusions entailed liver pathology, coagulopathy, malignancy, or those on prior prescribed blood thinners before THA. Multivariable regression was used, controlling for age and Charlson Comorbidity Index for all years, with 2011 as the reference year.
From 2011 to 2019, there was a significant reduction in 90-day VTE rates after THA, with a significant reduction in deep vein thrombosis and pulmonary embolism during this time frame as well. Of the antithrombotic agents prescribed after THA, the utilization of prescribed aspirin significantly increased and that of nonaspirin anticoagulants significantly decreased. Among nonaspirin anticoagulants, the utilization of direct factor Xa inhibitors and direct thrombin inhibitors significantly increased. The added reimbursements associated with VTE after THA significantly decreased during this period.
Since 2011, the incidence and economic burden associated with VTE after THA have significantly declined. In addition, there has been an increase in prescription aspirin and direct oral anticoagulants.
Therapeutic, III.
2011 年，美国矫形外科医师学会发布了一项临床实践指南，建议在全关节置换术后常规进行静脉血栓栓塞症（VTE）预防。本研究旨在研究：（1）90 天 VTE、深静脉血栓形成和肺栓塞的发生率变化；（2）抗血栓药物的使用变化；（3）2011 年至 2019 年全髋关节置换术（THA）后与 VTE 相关的经济负担变化。
使用国家行政索赔数据，对 2011 年至 2019 年期间接受原发性 THA 治疗骨关节炎的患者进行了识别。排除标准包括肝脏疾病、凝血障碍、恶性肿瘤或在 THA 之前已服用预定的血液稀释剂的患者。在所有年份中，使用多变量回归，控制年龄和 Charlson 合并症指数，2011 年为参考年。
2011 年至 2019 年，THA 后 90 天 VTE 发生率显著降低，在此期间深静脉血栓形成和肺栓塞的发生率也显著降低。在 THA 后开具的抗血栓药物中，处方阿司匹林的使用率显著增加，而非阿司匹林抗凝剂的使用率显著下降。在非阿司匹林抗凝剂中，直接因子 Xa 抑制剂和直接凝血酶抑制剂的使用率显著增加。THA 后与 VTE 相关的额外报销费用在此期间显著减少。
自 2011 年以来，THA 后 VTE 的发生率和经济负担显著下降。此外，处方阿司匹林和直接口服抗凝剂的使用有所增加。
治疗性，III 级。
