School of Pharmacy, University of Queensland, Brisbane, Queensland, Australia.
Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Intern Med J. 2024 Aug;54(8):1275-1282. doi: 10.1111/imj.16407. Epub 2024 May 22.
Aspirin is used for venous thromboembolism (VTE) prophylaxis after total hip and knee arthroplasty (THA/TKA). However, its efficacy is unclear in patients with multiple VTE risk factors and at risk of aspirin resistance (AR).
To determine the prevalence of risk factors for VTE and AR in patients after THA/TKA and to determine the relationship between risk factors and drugs prescribed for thromboprophylaxis.
A retrospective cohort study of elective-THA/TKA in six Australian hospitals over a 1-year period. Medical records were manually reviewed to determine demographics, thromboprophylaxis regimen and presence of risk factors. The relationship between individual and cumulative risk factors with the thromboprophylaxis regimen was determined.
In total, 1011 patients were included with a mean (SD) age of 65.9 (±11.0) years, and 56.4% were female. The five most prevalent risk factors were obesity (59.1%), age ≥65 years (58.2%), hypertension (45.3%), dyslipidaemia (35.9%) and diabetes (19.7%). Most patients had ≥1 risk factor for VTE (93.6%) and AR (93.6%), with 49.0% and 35.0% having ≥3 concurrent VTE and AR risk factors, respectively. The only significant relationship between risk factors and drugs was diabetes (P < 0.01). Rivaroxaban was more commonly used as the number of concurrent VTE risk factors increased (P < 0.05).
Patients had a high prevalence of VTE and AR risk factors, suggesting aspirin may not be beneficial in many patients. Only diabetes was linked to the selection of thromboprophylaxis. Patients who received rivaroxaban had a greater average number of VTE risk factors. Guidelines should promote individualised prescribing in higher-risk patients.
阿司匹林用于全髋关节和膝关节置换术（THA/TKA）后预防静脉血栓栓塞症（VTE）。然而，在存在多种 VTE 风险因素且存在阿司匹林抵抗（AR）风险的患者中，其疗效尚不清楚。
确定接受 THA/TKA 后患者 VTE 和 AR 的风险因素的流行率，并确定风险因素与用于血栓预防的药物之间的关系。
对澳大利亚六家医院进行了为期 1 年的择期 THA/TKA 回顾性队列研究。手动审查病历以确定人口统计学特征、血栓预防方案和存在的风险因素。确定个体和累积风险因素与血栓预防方案之间的关系。
共纳入 1011 例患者，平均（SD）年龄为 65.9（±11.0）岁，56.4%为女性。最常见的五个风险因素是肥胖（59.1%）、年龄≥65 岁（58.2%）、高血压（45.3%）、血脂异常（35.9%）和糖尿病（19.7%）。大多数患者存在 VTE（93.6%）和 AR（93.6%）的危险因素≥1 个，分别有 49.0%和 35.0%同时存在≥3 个 VTE 和 AR 危险因素。风险因素与药物之间唯一具有显著相关性的是糖尿病（P<0.01）。随着同时存在的 VTE 危险因素数量的增加，利伐沙班的使用更为常见（P<0.05）。
患者存在 VTE 和 AR 风险因素的高发率，这表明阿司匹林可能对许多患者无益。只有糖尿病与血栓预防药物的选择有关。接受利伐沙班的患者具有更多的平均 VTE 风险因素。指南应促进对高风险患者进行个体化处方。
