全关节置换术后低剂量（162毫克）与高剂量（650毫克）阿司匹林预防效果的比较：一项前瞻性队列研究。
Comparison of low-dose (162 mg) and high-dose (650 mg) Aspirin prophylaxis following total joint arthroplasty: a prospective cohort study.
作者信息
Shafiei Seyyed Hossein, Rastegar Mohammad, Mirghaderi Peyman, Siavashi Babak, Mortazavi Seyed Mohammad Javad
机构信息
Orthopedic Surgery Research Centre, Sina University Hospital.
Joint Reconstruction Research Center.
出版信息
Ann Med Surg (Lond). 2023 Apr 17;85(5):1461-1467. doi: 10.1097/MS9.0000000000000366. eCollection 2023 May.
UNLABELLED
Since Aspirin's adverse effects are dose-dependent, and evidence supporting the use of low-dose (LD) Aspirin in preventing venous thromboembolism (VTE) after total hip arthroplasty (THA) is weak, the authors do not know what the minimal effective dosage of Aspirin is to prevent VTE. This study aimed to compare the rates of 90-day symptomatic VTE following THA and total knee arthroplasty in healthy patients taking LD Aspirin vs. high-dose (HD) Aspirin for 6 weeks postoperatively.
MATERIALS AND METHODS
A prospective cohort of patients with THA and total knee arthroplasty was conducted at two tertiary centres. Symptomatic VTE within 90 days of index arthroplasty was the primary outcome; gastrointestinal bleeding (GIB) and mortality were secondary outcomes.
RESULTS
The final analysis included 312 consecutive patients: 158 in the LD group and 154 in the HD group. Two groups were similar regarding preoperative data, including sex, age, BMI, smoking, diabetes mellitus, Hgb and platelet count, and type of surgery. The LD group had one deep vein thrombosis (0.6%), and the HD group had two (1.3%) (=0.62). Neither group had PTE. Therefore, VTE rates are the same as deep vein thrombosis rates and similar between the groups (0.6% vs. 1.3%, =0.62)Regarding GIB due to anticoagulant therapy, no patient in the LD group reported GIB, whereas two (1.3%) patients in the HD group reported GIB within 90 days of arthroplasty. GIB rates did not differ significantly between groups (=0.24). Considering VTE + GIB combined, the HD groups showed a higher rate of complications (=4, 2.6%) than the LD groups (=1, 0.6%) but not statistically significant (=0.21).
CONCLUSIONS
Prophylactic administration of Aspirin with low doses (81 mg BID) and high doses (325 mg BID) for six weeks is equally effective at reducing VTE in total joint arthroplasty patients and had similar adverse effects.
LEVEL OF EVIDENCE
Therapeutic Level II.
未标注
由于阿司匹林的不良反应具有剂量依赖性，且支持在全髋关节置换术（THA）后使用低剂量（LD）阿司匹林预防静脉血栓栓塞（VTE）的证据不足，作者并不清楚预防VTE的阿司匹林最小有效剂量是多少。本研究旨在比较健康患者在THA和全膝关节置换术后服用LD阿司匹林与高剂量（HD）阿司匹林6周后90天有症状VTE的发生率。
材料与方法
在两个三级中心对THA和全膝关节置换术患者进行前瞻性队列研究。关节置换术后90天内有症状的VTE为主要结局；胃肠道出血（GIB）和死亡率为次要结局。
结果
最终分析纳入312例连续患者：LD组158例，HD组154例。两组术前数据相似，包括性别、年龄、体重指数、吸烟、糖尿病、血红蛋白和血小板计数以及手术类型。LD组有1例深静脉血栓形成（0.6%），HD组有2例（1.3%）（P = 0.62）。两组均无肺栓塞（PTE）。因此，VTE发生率与深静脉血栓形成率相同，两组相似（0.6%对1.3%，P = 0.62）。关于抗凝治疗导致的GIB，LD组无患者报告GIB，而HD组有2例（1.3%）患者在关节置换术后90天内报告GIB。两组GIB发生率差异无统计学意义（P = 0.24）。考虑VTE + GIB联合情况，HD组并发症发生率（4例，2.6%）高于LD组（1例，0.6%），但差异无统计学意义（P = 0.21）。
结论
低剂量（81毫克，每日两次）和高剂量（325毫克，每日两次）阿司匹林预防性给药6周在降低全关节置换术患者VTE方面同样有效，且不良反应相似。
证据水平
治疗水平II。
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