Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 14th Floor, Suite 14-02, New York, NY, 10003, USA.
Eur J Orthop Surg Traumatol. 2024 Apr;34(3):1405-1411. doi: 10.1007/s00590-023-03816-3. Epub 2024 Jan 10.
Venous thromboembolism (VTE) is a known complication of hip arthroplasty for femoral neck fractures (FNF) with various prophylactic anticoagulants utilized to decrease risk. The purpose of this study was to assess the efficacy and perioperative outcomes associated with aspirin for VTE prophylaxis following arthroplasty for FNF.
Medical records of 1,220 patients who underwent hip hemiarthroplasty (HHA) or total hip arthroplasty (THA) at an urban academic center from 2011 to 2022 were retrospectively reviewed. Patient characteristics and perioperative outcomes, including length of stay (LOS), VTE, 90-day hospital encounters, and discharge disposition, were collected. Outcomes for patients prescribed aspirin (n = 214) were compared to those prescribed non-aspirin VTE prophylaxis (n = 1006) using propensity score matching.
Patients who received aspirin had higher rates of THA (36.0 vs 26.7%; p = 0.008). There were no significant risk-adjusted differences in the incidence of VTE (0.5 vs 0.5%, p = 1.000) and 90-day readmissions (10.4 vs 12.3%, p = 0.646) between patients prescribed aspirin and non-aspirin VTE prophylaxis, respectively. Patients prescribed non-aspirin agents had higher rates of non-home discharge (73.9 vs 58.5%; p < 0.001) and longer LOS (143.5 vs 124.9 h; p = 0.005). Sub-analysis of patients prescribed aspirin and non-aspirin prophylaxis based on comorbidity scores demonstrated no difference in VTE incidence for low (0.0 vs 1.6%, p = 1.000) and high scores (0.0 vs 0.0%, p = 1.000), respectively.
Aspirin is not associated with increased incidence of VTE after HHA or THA for FNF. Aspirin prophylaxis should be considered in hip fracture patients to mitigate bleeding risk, particularly those with low to intermediate VTE risk.
Level III, Retrospective study.
静脉血栓栓塞症（VTE）是股骨颈骨折（FNF）髋关节置换术的已知并发症，各种预防性抗凝剂被用于降低风险。本研究旨在评估在 FNF 髋关节置换术后使用阿司匹林预防 VTE 的疗效和围手术期结局。
回顾性分析了 2011 年至 2022 年在一家城市学术中心接受髋关节半髋关节置换术（HHA）或全髋关节置换术（THA）的 1220 例患者的病历。收集了患者特征和围手术期结局，包括住院时间（LOS）、VTE、90 天内住院次数和出院去向。使用倾向评分匹配比较了接受阿司匹林治疗（n=214）和接受非阿司匹林 VTE 预防治疗（n=1006）的患者的结局。
接受阿司匹林治疗的患者中 THA 比例较高（36.0% vs. 26.7%；p=0.008）。接受阿司匹林和非阿司匹林 VTE 预防治疗的患者 VTE 发生率（0.5% vs. 0.5%，p=1.000）和 90 天内再入院率（10.4% vs. 12.3%，p=0.646）无显著风险调整差异。接受非阿司匹林药物治疗的患者非家庭出院率较高（73.9% vs. 58.5%；p<0.001），住院时间较长（143.5 小时 vs. 124.9 小时；p=0.005）。基于合并症评分对接受阿司匹林和非阿司匹林预防治疗的患者进行亚组分析，低（0.0% vs. 1.6%，p=1.000）和高评分（0.0% vs. 0.0%，p=1.000）患者的 VTE 发生率无差异。
在 FNF 的 HHA 或 THA 后，阿司匹林并不增加 VTE 的发生率。在髋关节骨折患者中，应考虑使用阿司匹林预防 VTE，以降低出血风险，特别是那些 VTE 风险低至中等的患者。
III 级，回顾性研究。
