低分子量肝素、阿司匹林及其联合用药对肥胖患者全膝关节置换术后血栓形成预防作用的比较。
Comparison of low molecular weight heparin, aspirin, and their combination for the prevention of thrombosis after total knee arthroplasty in obese patients.
作者信息
Mirahmadi Alireza, Hosseini-Monfared Pooya, Ghane Shahrzad, Mortazavi Mohammad, Abrishami Ramin, Hooshangi Mohammad Hossein, Shameli Vahid, Kazemi Seyed Morteza
机构信息
Bone Joint and Related Tissues Research Center Shahid Beheshti University of Medical Sciences Tehran Iran.
Clinical Department Pharmacy school, Islamic Azad University Tehran Medical Sciences Tehran Iran.
出版信息
J Exp Orthop. 2025 Mar 18;12(1):e70218. doi: 10.1002/jeo2.70218. eCollection 2025 Jan.
PURPOSE
Patients undergoing total knee arthroplasty (TKA) are at a high risk of thromboembolic events, which is higher in obese patients. Determining the appropriate prophylaxis for venous thromboembolism (VTE) in obese patients is challenging. Therefore, we aimed to compare the effects of low molecular weight heparin (LMWH) with aspirin (ASA) and their combination for the prevention of thromboembolic events after TKA in obese patients.
METHODS
In a retrospective study, 245 obese patients with BMIs over 30 who underwent TKA were enroled. Eligible patients were divided into three groups: Group A was given LMWH sodium (Clexane®) for 14 days, Group B was given ASA for 14 days, and Group C was given LMWH sodium (Clexane®) for 5 days and then ASA twice daily for the days between 5 and 14 postoperatively. The primary outcome was the incidence of VTE within three months. Secondary outcomes included routine laboratory evaluations (PT, PTT, INR, Hb, Hct, platelets, BUN and Cr) and adverse effects of ASA and LMWH, such as bleeding, anaemia, thrombocytopenia, and gastrointestinal or neurological symptoms.
RESULTS
Regarding the incidence of DVT and PTE, we did not observe significant differences between groups ( > 0.05). A total of seven symptomatic VTE was observed in six patients. We observed two cases with PE who were in the Clexane group. Moreover, five individuals had DVT in the follow-up: three cases in the Clexane group, one in the ASA group, and one in the ASA + Clexane group, which was not statistically significant ( > 0.05). There were no differences between groups regarding the risk of adverse events and complications.
CONCLUSION
We found that ASA is not inferior to enoxaparin in reducing VTE after TKA in obese patients. Therefore, given ASA's low cost and greater convenience, it may be considered a reasonable alternative for extended VTE prophylaxis for TKA surgery in obese patients.
LEVEL OF EVIDENCE
Level III.
目的
接受全膝关节置换术（TKA）的患者发生血栓栓塞事件的风险很高，肥胖患者的风险更高。确定肥胖患者静脉血栓栓塞（VTE）的适当预防措施具有挑战性。因此，我们旨在比较低分子量肝素（LMWH）与阿司匹林（ASA）及其联合用药对肥胖患者TKA术后预防血栓栓塞事件的效果。
方法
在一项回顾性研究中，纳入了245例体重指数超过30的肥胖患者，这些患者接受了TKA。符合条件的患者分为三组：A组给予低分子量肝素钠（克赛®）14天，B组给予ASA 14天，C组给予低分子量肝素钠（克赛®）5天，然后在术后5至14天每天服用两次ASA。主要结局是三个月内VTE的发生率。次要结局包括常规实验室评估（PT、PTT、INR、Hb、Hct、血小板、BUN和Cr）以及ASA和LMWH的不良反应，如出血、贫血、血小板减少以及胃肠道或神经系统症状。
结果
关于深静脉血栓形成（DVT）和肺栓塞（PTE）的发生率，我们未观察到组间有显著差异（P＞0.05）。在6例患者中总共观察到7例有症状的VTE。我们在克赛组中观察到2例有PE的患者。此外，在随访中有5例发生DVT：克赛组3例，ASA组1例，ASA+克赛组1例，差异无统计学意义（P＞0.05）。在不良事件和并发症风险方面，组间无差异。
结论
我们发现，在肥胖患者TKA术后降低VTE方面，ASA并不劣于依诺肝素。因此，鉴于ASA成本低且更方便，它可被认为是肥胖患者TKA手术延长VTE预防的合理替代方案。
证据级别
三级。
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