Aspirin May Be a Suitable Prophylaxis for Patients with a History of Venous Thromboembolism Undergoing Total Joint Arthroplasty

Leanne Ludwick, N. Shohat, Duncan S Van Nest, J. Paladino, Jonathan Ledesma, J. Parvizi
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引用次数: 2

Abstract

Background: In recent years, aspirin has become a popular agent for venous thromboembolism (VTE) prophylaxis following total joint arthroplasty (TJA). Yet patients with a history of VTE are often given more aggressive prophylactic agents because of their increased baseline risk. The purpose of this study was to assess whether aspirin is an effective prophylactic agent in patients with a history of VTE. Methods: This was a single-institution, retrospective cohort study. The electronic clinical records of 36,333 patients undergoing TJA between 2008 and 2020 were reviewed. Data on demographic characteristics, comorbidities, intraoperative factors, and postoperative complications were collected. A propensity score-matched analysis was performed, as well as a multivariate regression analysis to account for confounders. Results: Of the 36,333 patients undergoing TJA, 1,087 patients (3.0%) had a history of VTE and were not receiving chronic non-aspirin. The risk for subsequent VTE was significantly higher (p = 0.03) in patients with a history of VTE (1.4%) compared with patients without prior VTE (0.9%). However, the incidence of VTE was not significantly lower (p = 0.208) in patients with a history of VTE who received aspirin (0.4%) compared with patients who received other VTE prophylaxis (1.5%). Propensity score matching showed no difference in VTE rates between the 2 groups (2.2% compared with 0.55%; p = 0.372). In a regression analysis accounting for VTE risk, the administration of aspirin was not associated with an increased risk for subsequent VTE (adjusted odds ratio, 0.32 [95% confidence interval, 0.02 to 1.66]; p = 0.274). Conclusions: Our findings suggest that, although patients with a history of VTE have an increased baseline risk for subsequent VTE, aspirin may be a suitable VTE prophylaxis in this group of patients. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
阿司匹林可能是一个合适的预防患者有静脉血栓栓塞史进行全关节置换术
背景:近年来,阿司匹林已成为全关节置换术(TJA)后静脉血栓栓塞(VTE)预防的常用药物。然而,有静脉血栓栓塞病史的患者由于其基线风险增加,通常给予更积极的预防药物。本研究的目的是评估阿司匹林对有静脉血栓栓塞病史的患者是否有效。方法:这是一项单机构、回顾性队列研究。回顾了2008年至2020年间36333例TJA患者的电子临床记录。收集了人口学特征、合并症、术中因素和术后并发症的数据。进行倾向评分匹配分析,以及多变量回归分析,以解释混杂因素。结果:在36333例接受TJA的患者中,1087例(3.0%)患者有静脉血栓栓塞病史,且未接受慢性非阿司匹林治疗。有静脉血栓栓塞病史的患者发生静脉血栓栓塞的风险(1.4%)明显高于无静脉血栓栓塞病史的患者(0.9%)(p = 0.03)。然而,有静脉血栓栓塞病史的患者服用阿司匹林(0.4%)与服用其他静脉血栓栓塞预防药物的患者(1.5%)相比,静脉血栓栓塞的发生率并没有显著降低(p = 0.208)。倾向评分匹配显示两组间静脉血栓栓塞发生率无差异(2.2%比0.55%;P = 0.372)。在考虑静脉血栓栓塞风险的回归分析中,阿司匹林的使用与随后发生静脉血栓栓塞的风险增加无关(校正优势比为0.32[95%可信区间,0.02至1.66];P = 0.274)。结论:我们的研究结果表明,尽管有静脉血栓栓塞病史的患者随后发生静脉血栓栓塞的基线风险增加,但阿司匹林可能是这组患者预防静脉血栓栓塞的合适药物。证据等级:治疗性III级。有关证据水平的完整描述,请参见作者说明。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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