Yale Department of Orthopaedics and Rehabilitation, New Haven, Connecticut.
J Arthroplasty. 2024 Oct;39(10):2421-2426. doi: 10.1016/j.arth.2024.05.083. Epub 2024 Jun 3.
Total hip arthroplasty (THA) is a common procedure that requires consideration of preexisting comorbidities. Factor V Leiden (FVL), an inherited thrombophilia, is one such condition that predisposes patients to venous thromboembolism (VTE, deep vein thrombosis, and pulmonary embolism). The present study aimed to characterize the risks associated with FVL patients undergoing THA and evaluate the effect of VTE chemoprophylactic agents on these risks.
A total of 544,022 adult patients who underwent primary THA for osteoarthritis indications between 2010 and October 2021 were identified in an administrative claims database. Of these, FVL was identified in 1,138 (0.21%). Patients who had and did not have FVL were matched at a 1:4 ratio (1,131 with FVL and 4,519 without FVL) based on age, sex, and Elixhauser comorbidity index. Univariable and multivariable analyses were assessed for 90-day complications. Implant survival at 5 years was assessed and compared with log-rank tests. The relative use of different chemoprophylactic agents, including aspirin, warfarin, heparin, or direct oral anticoagulant (DOAC), was assessed. Bleeding events and VTE were compared for those prescribed either aspirin or warfarin, heparin, or DOAC. A Bonferroni correction was applied.
On multivariable analysis, FVL patients were found to have increased odds of 90-day deep vein thrombosis (odds ratio (OR) = 9.20), pulmonary embolism (OR = 6.89), and aggregated severe and all adverse events (OR = 4.74 and 1.98, respectively), but not elevated risk of other perioperative adverse events or 5-year reoperations. More potent chemoprophylactic agents (warfarin, heparin, DOAC) reduced, but did not completely eliminate, the increased VTE risks (without increasing bleeding events).
This study quantified the significantly elevated VTE risk associated with FVL patients undergoing THA. The lack of difference in other specific adverse events and 5-year reoperations is reassuring. Clearly, chemoprophylactic agents are important in this population and may need further attention.
全髋关节置换术（THA）是一种常见的手术，需要考虑到先前存在的合并症。因子 V 莱顿（FVL）是一种遗传性血栓形成倾向，可使患者易患静脉血栓栓塞症（VTE，深静脉血栓形成和肺栓塞）。本研究旨在描述接受 THA 的 FVL 患者的相关风险，并评估 VTE 化学预防药物对这些风险的影响。
在一个行政索赔数据库中，共确定了 2010 年至 2021 年 10 月间因骨关节炎指征接受初次 THA 的 544,022 名成年患者。其中，1,138 名（0.21%）患者被确定为 FVL。根据年龄、性别和 Elixhauser 合并症指数，对患有和不患有 FVL 的患者进行 1:4 比例的匹配（1,131 名患有 FVL 和 4,519 名不患有 FVL）。对 90 天并发症进行单变量和多变量分析。采用对数秩检验评估 5 年的植入物存活率并进行比较。评估不同化学预防药物（包括阿司匹林、华法林、肝素或直接口服抗凝剂（DOAC））的相对使用情况。比较了处方阿司匹林或华法林、肝素或 DOAC 的患者的出血事件和 VTE。应用了 Bonferroni 校正。
多变量分析发现，FVL 患者 90 天深静脉血栓形成（比值比（OR）=9.20）、肺栓塞（OR=6.89）和严重及所有不良事件（OR=4.74 和 1.98）的风险增加，但其他围手术期不良事件或 5 年再手术的风险并未升高。更有效的化学预防药物（华法林、肝素、DOAC）降低了但并未完全消除 VTE 风险的增加（不会增加出血事件）。
本研究量化了接受 THA 的 FVL 患者显著增加的 VTE 风险。其他特定不良事件和 5 年再手术无差异的情况令人安心。显然，化学预防药物在该人群中很重要，可能需要进一步关注。
