Chokshi Shivan N, Gay Samuel S, Barimani Bardia, Somerson Jeremy S
John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, Texas.
Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas.
J Arthroplasty. 2025 Sep;40(9):2387-2392. doi: 10.1016/j.arth.2025.03.072. Epub 2025 Mar 28.
Major orthopaedic procedures, such as total hip arthroplasty (THA) and total knee arthroplasty (TKA), carry risk for thrombotic complications. To reduce the incidence of postoperative venous thromboembolism (VTE), surgical patients are often prescribed antiplatelet or anticoagulant treatment. The objective of this study was to compare rates of VTE events and complications between apixaban and aspirin for VTE prophylaxis following primary THA and TKA.
We searched a research network using Current Procedural Terminology and International Classification of Diseases, Tenth Revision codes for patients who underwent a THA or TKA from 2018 to 2023. Patients were then categorized into cohorts of patients who received only aspirin (81 or 325 mg, twice daily) or patients who received only apixaban (2.5 mg, twice daily) for VTE prophylaxis. Odds ratios with 95% confidence intervals were calculated to compare the associations of selected prophylaxis with VTE events and complications, and Chi-square analyses were performed to determine the significance of differences. Statistical significance was defined as a two-sided alpha value < 0.05.
Patients who received apixaban after THA had increased odds of deep vein thrombosis (5.22, 4.60 to 5.93), pulmonary embolism (7.85, 6.55 to 9.41), transfusion (1.5, 1.27 to 1.81), hemarthrosis (1.87, 1.26 to 2.24), myocardial infarction (1.12, 1.03 to 1.23), and readmission (1.18, 1.09 to 1.28) within 90 days after surgery. Patients who received apixaban after TKA had increased odds of deep vein thrombosis (4.57, 4.15 to 5.02), pulmonary embolism (6.05, 5.33 to 6.88), transfusion (1.6, 1.36 to 1.96), hemarthrosis (1.48, 1.03 to 2.12), myocardial infarction (1.42, 1.29 to 1.63), stroke (1.16, 1.09 to 1.53), and readmission (1.84, 1.61 to 2.11) within 90 days after TKA.
Apixaban is associated with increased odds of thrombotic events and bleeding complications in the postoperative period of THA and TKA compared to aspirin. This highlights the potential risks associated with apixaban use and the importance of using data to guide patient management in the absence of standardized clinical guidelines.
大型骨科手术，如全髋关节置换术（THA）和全膝关节置换术（TKA），存在血栓形成并发症的风险。为降低术后静脉血栓栓塞症（VTE）的发生率，手术患者常被开具抗血小板或抗凝治疗药物。本研究的目的是比较阿哌沙班和阿司匹林在初次THA和TKA后预防VTE时的VTE事件发生率和并发症。
我们使用当前手术操作术语和国际疾病分类第十版编码在一个研究网络中搜索2018年至2023年接受THA或TKA的患者。然后将患者分为仅接受阿司匹林（81毫克或325毫克，每日两次）进行VTE预防的队列或仅接受阿哌沙班（2.5毫克，每日两次）进行VTE预防的队列。计算95%置信区间的比值比，以比较所选预防措施与VTE事件和并发症的关联，并进行卡方分析以确定差异的显著性。统计学显著性定义为双侧α值<0.05。
THA后接受阿哌沙班的患者在术后90天内发生深静脉血栓形成（5.22，4.60至5.93）、肺栓塞（7.85，6.55至9.41）、输血（1.5，1.27至1.81）、关节积血（1.87，1.26至2.24）、心肌梗死（1.12，1.03至1.23）和再次入院（1.18，1.09至1.28）的几率增加。TKA后接受阿哌沙班的患者在TKA后90天内发生深静脉血栓形成（4.57，4.15至5.02）、肺栓塞（6.05，5.33至6.88）、输血（1.6，1.36至1.96）、关节积血（1.48，1.03至2.12）、心肌梗死（1.42，1.29至1.63）、中风（1.16，1.09至1.53）和再次入院（1.84，1.61至2.11）的几率增加。
与阿司匹林相比，阿哌沙班在THA和TKA术后与血栓形成事件和出血并发症几率增加相关。这突出了使用阿哌沙班的潜在风险以及在缺乏标准化临床指南时利用数据指导患者管理的重要性。
