Lee Yea-Ji, Lee Jaemoon, Hong Seung-Wan, Kim Seong-Hyop
Department of Anaesthesiology and Pain Medicine, Konkuk University Medical Centre, Seoul 05030, Republic of Korea.
Department of Infection and Immunology, School of Medicine, Konkuk University, Seoul 05030, Republic of Korea.
Medicina (Kaunas). 2025 Apr 15;61(4):729. doi: 10.3390/medicina61040729.
: Hip surgery is increasingly performed among elderly patients. Oral antithrombotics, which are taken for patients' underlying diseases, are a main concern regarding perioperative bleeding. Postoperative venous thromboembolism (VTE) is a leading cause of mortality after hip surgery. Therefore, administration of preoperative oral antithrombotics is a double-edged sword in hip surgery. In this study, we examined the correlation between the occurrence of postoperative VTE and the type of oral antithrombotics administered preoperatively. : We analyzed the medical records of 601 patients aged 19 and over who underwent hip surgery from January 2021 to June 2023. The patients were assigned to two groups as follows: Groups VTE+ (patients who developed postoperative VTE) and VTE- (patients who did not develop postoperative VTE), respectively. : Of the 139 patients who had been taking oral antithrombotics for 6 months or more, 24 were allocated to group VTE+ and 115 to group VTE-, respectively. The number of patients who took clopidogrel and cilostazol was significantly higher in groups VTE- and VTE+, respectively (12.5 vs. 33.9%, = 0.038, odds ratio (OR) = 0.278, 95% confidence interval (CI) = 0.078-0.991; 20.8 vs. 5.2%, = 0.010, 95% CI = 1.325-17.245; group VTE+ vs. group VTE-). Preoperative albumin levels were significantly lower in group VTE+ (3.4 ± 0.6 g/dL vs. 3.7 ± 0.4 g/dL, = 0.004, OR = 0.285, 95% CI = 0.115-0.702). In multivariate regression analysis, the results were statistically significant for clopidogrel, cilostazol, and preoperative albumin levels ( = 0.035, OR = 0.237, 95% CI = 0.062-0.901; = 0.011, OR = 6.479, 95% CI = 1.542-27.226; = 0.002, OR = 0.211, 95% CI = 0.080-0.558). : Among the patients who had been taking oral antithrombotics for ≥6 months, clopidogrel had a prophylactic effect, but cilostazol showed an aggravating effect on postoperative VTE in hip surgery. Preoperative hypoalbuminemia increases the risk of postoperative VTE in hip surgery.
髋关节手术在老年患者中越来越常见。用于治疗患者基础疾病的口服抗血栓药物是围手术期出血的主要关注点。术后静脉血栓栓塞（VTE）是髋关节手术后死亡的主要原因。因此，术前口服抗血栓药物的使用在髋关节手术中是一把双刃剑。在本研究中，我们探讨了术后VTE的发生与术前服用的口服抗血栓药物类型之间的相关性。
我们分析了2021年1月至2023年6月期间接受髋关节手术的601例19岁及以上患者的病历。患者被分为两组：VTE +组（发生术后VTE的患者）和VTE -组（未发生术后VTE的患者）。
在139例服用口服抗血栓药物6个月或更长时间的患者中，分别有24例被分配到VTE +组，115例被分配到VTE -组。服用氯吡格雷和西洛他唑的患者数量在VTE -组和VTE +组中分别显著更高（12.5%对33.9%，P = 0.038，比值比（OR）= 0.278，95%置信区间（CI）= 0.078 - 0.991；20.8%对5.2%，P = 0.010，95% CI = 1.325 - 17.245；VTE +组对VTE -组）。VTE +组术前白蛋白水平显著更低（3.4±0.6 g/dL对3.7±0.4 g/dL，P = 0.004，OR = 0.285，95% CI = 0.115 - 0.702）。在多因素回归分析中，氯吡格雷、西洛他唑和术前白蛋白水平的结果具有统计学意义（P = 0.035，OR = 0.237，95% CI = 0.062 - 0.901；P = 0.011，OR = 6.479，95% CI = 1.542 - 27.226；P = 0.002，OR = 0.211，95% CI = 0.080 - 0.558）。
在服用口服抗血栓药物≥6个月的患者中，氯吡格雷具有预防作用，但西洛他唑在髋关节手术中对术后VTE有加重作用。术前低白蛋白血症会增加髋关节手术术后VTE的风险。
