Zhao Amy Y, Gu Alex, Shah Aribah, Das Avilash, Parel Philip M, Debritz James N, Sterling Robert S
Department of Orthopaedic Surgery, George Washington University, Washington, District of Columbia.
J Arthroplasty. 2025 Sep;40(9):2393-2398. doi: 10.1016/j.arth.2025.03.059. Epub 2025 Mar 23.
Although patients who undergo arthroplasty for hip fractures are at high risk of venous thromboembolism (VTE), current guidelines do not specify the optimal VTE prophylactic agent. Recent evidence demonstrates that aspirin (ASA) may be safe and effective for VTE prevention in these patients. The purpose of this study was to determine the safety and efficacy of low-dose ASA (81 mg) compared to non-ASA agents after arthroplasty for femoral neck fracture.
A total of 36,576 patients who underwent arthroplasty for femoral neck fracture from January 2012 through December 2023 were identified in a national database. Patients were stratified by baseline VTE risk into high-risk and standard-risk groups and further categorized based on the type of VTE prophylaxis received - low-dose ASA only or non-ASA prophylaxis only. Rates and odds of deep vein thrombosis, pulmonary embolism (PE), and adverse events, including bleeding, blood transfusion requirements, and emergency department visits, were assessed in the 90-days postoperative period for propensity-matched cohorts.
Compared to non-ASA prophylaxis, use of low-dose ASA only was associated with significantly lower odds of deep vein thrombosis in both high-risk (odds ratio [OR]: 0.46; 95% confidence interval [CI]: 0.30 to 0.69) and standard-risk (OR: 0.37; 95% CI: 0.18 to 0.76) groups, and lower odds of PE in high-risk patients (OR: 0.27; 95% CI: 0.14 to 0.55). There were no significant differences in odds of PE in standard-risk patients (OR: 0.71; 95% CI: 0.32 to 1.61). Low-dose ASA was associated with lower odds of bleeding events, blood transfusion requirements, and emergency department visits.
Use of low-dose ASA is safe and effective in preventing VTE in patients undergoing arthroplasty for femoral neck fracture. As this population is at higher risk of mortality, prospective studies comparing VTE prophylaxis regimens are necessary to further improve clinical outcomes.
III.
尽管接受髋关节骨折置换术的患者发生静脉血栓栓塞症（VTE）的风险很高，但目前的指南并未明确最佳的VTE预防药物。最近的证据表明，阿司匹林（ASA）可能对预防这些患者的VTE安全有效。本研究的目的是确定与非ASA药物相比，低剂量ASA（81毫克）在股骨颈骨折置换术后预防VTE的安全性和有效性。
在一个国家数据库中识别出2012年1月至2023年12月期间共36576例接受股骨颈骨折置换术的患者。根据基线VTE风险将患者分为高危组和标准风险组，并根据接受的VTE预防类型进一步分类——仅接受低剂量ASA或仅接受非ASA预防。在术后90天内，对倾向匹配队列的深静脉血栓形成、肺栓塞（PE）以及不良事件（包括出血、输血需求和急诊科就诊）的发生率和比值比进行评估。
与非ASA预防相比，仅使用低剂量ASA与高危组（比值比[OR]：0.46；95%置信区间[CI]：0.30至0.69）和标准风险组（OR：0.37；95%CI：0.18至0.76）深静脉血栓形成的比值比显著降低相关，并且与高危患者PE的比值比降低相关（OR：0.27；95%CI：0.14至0.55）。标准风险患者PE的比值比无显著差异（OR：0.71；95%CI：0.32至1.61）。低剂量ASA与出血事件、输血需求和急诊科就诊的比值比降低相关。
低剂量ASA在预防股骨颈骨折置换术患者的VTE方面安全有效。由于该人群的死亡风险较高，有必要进行前瞻性研究比较VTE预防方案，以进一步改善临床结局。
III级。
