髋关节高度发育性发育不良THA术后阿司匹林预防静脉血栓栓塞的高风险:回顾性比较研究。

IF 4.4 2区 医学 Q1 ORTHOPEDICS
Kaveh Gharanizadeh,Hadi Ravanbod,Mohammad Poursalehian,Arvin Medhat,Amir Aminian,Maziar Rajei,Mohammad Hassanzadeh,Mansour Abolghasemian
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Additionally, we investigated possible risk factors for VTE within this specific patient group.\r\n\r\nQUESTIONS/PURPOSES\r\n(1) Is the risk of symptomatic VTE (all deep vein thrombosis [DVT] plus pulmonary embolism, or proximal DVT plus pulmonary embolism) increased in patients undergoing THA for severe DDH, defined as Crowe type III or IV, compared with patients undergoing THA for other reasons when aspirin is used for prophylaxis? (2) In patients with severe DDH undergoing THA, are there specific identifiable risk factors associated with an increased risk of symptomatic VTE?\r\n\r\nMETHODS\r\nBetween June and November 2021, an arthroplasty surgeon performed 153 consecutive primary THAs on 146 patients across two arthroplasty centers. All patients except those with a history of prior VTE or those on chronic anticoagulation received aspirin as pharmacologic prophylaxis for VTE. No routine surveillance for VTE was used. To be eligible for this retrospective comparative study, a chart note documenting any signs or symptoms of symptomatic VTE had to be present at least 3 months postoperatively. Patients were excluded for the following reasons: they had a personal history of VTE (1% [2 of 146]), they were receiving ongoing anticoagulant therapy (2% [3 of 146]), they were out of the age criteria range (2% [3 of 146]), they had undergone same-setting bilateral THAs or the second side of staged bilateral THAs (3% [4 of 146]), or they were lost to follow-up within 90 days after surgery (0% [0]). After exclusions, 134 patients (134 hips) remained. Patients were divided into two groups based on their preoperative diagnosis: (1) high-riding DDH of Crowe type III or IV (35% [47 of 134] of hips) and (2) all other diagnoses, including primary or inflammatory arthritis, Crowe type I or II DDH, fracture, and osteonecrosis (65% [87 of 134] of hips). A comprehensive records review was conducted to determine the incidence of symptomatic VTE, including distal DVT, proximal DVT, or pulmonary embolism. Patients' demographics, surgical details, and outcomes were compared between the groups. The high-riding group had longer operations and a higher percentage of patients having general anesthesia, acetabular bone grafting, transfusions, or restricted weightbearing postoperatively. Univariable analysis was performed to compare the high-riding DDH group with the control group and to evaluate associations between potential risk factors and symptomatic VTE. Subsequently, multivariable logistic regression was conducted to identify independent risk factors among the variables identified in the univariable analysis.\r\n\r\nRESULTS\r\nPatients undergoing THA for DDH had higher odds of experiencing symptomatic VTE compared with the control group (17% [8 of 47] versus 1% [1 of 87], OR 18 [95% confidence interval (CI) 2 to 146]; p = 0.001). After adjusting for confounding variables such as age, sex, American Society of Anesthesiologists grading, anesthesia type, operation duration, shortening osteotomy, shelf/impaction grafting, and blood transfusion, patients undergoing THA for high-riding DDH still had higher adjusted odds of symptomatic VTE compared with the other group (adjusted OR 67 [95% CI 3 to 151]; p = 0.008). When considering only proximal DVT or pulmonary embolism events (excluding distal DVT), the odds of experiencing a VTE event remained higher in patients with high-riding DDH compared with the other group (11% [5 of 47] versus 1% [1 of 87], OR 10 [95% CI 1 to 90]; p = 0.02). 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引用次数: 0

摘要

背景:尽管取得了进展,THA仍然与风险相关,特别是静脉血栓栓塞(VTE)。高位发育性髋关节发育不良(DDH)患者的THA可能与静脉血栓栓塞(VTE)风险升高有关。我们进行了一项研究,以评估与接受其他诊断的原发性THA患者相比,接受THA和阿司匹林的高位DDH患者发生症状性静脉血栓栓塞的风险是否增加。问题/目的(1)当使用阿司匹林进行预防时,因严重DDH(定义为Crowe III型或IV型)而接受THA的患者,与因其他原因接受THA的患者相比,发生症状性VTE(所有深静脉血栓形成[DVT]加肺栓塞,或近端DVT加肺栓塞)的风险是否增加?(2)重度DDH患者行THA,是否存在与症状性静脉血栓栓塞风险增加相关的特定可识别的危险因素?方法在2021年6月至11月期间,一名关节置换外科医生在两个关节置换中心对146名患者进行了153次连续的初级tha手术。除了有静脉血栓栓塞病史或慢性抗凝治疗的患者外,所有患者均接受阿司匹林作为静脉血栓栓塞的药物预防。未进行静脉血栓栓塞常规监测。为了符合这项回顾性比较研究的资格,必须在术后至少3个月出现任何症状性静脉血栓栓塞的体征或症状。排除患者的原因如下:有静脉血栓栓塞个人病史(1%[146例中2例]),正在接受抗凝治疗(2%[146例中3例]),不在年龄标准范围内(2%[146例中3例]),接受过相同设置的双侧tha或分阶段双侧tha(3%[146例中4例]),或术后90天内未随访(0%[0])。排除后,134例患者(134髋)保留。患者根据术前诊断分为两组:(1)Crowe III型或IV型高骑行性DDH(35%[134人中的47人]髋)和(2)所有其他诊断,包括原发性或炎性关节炎、Crowe I型或II型DDH、骨折和骨坏死(65%[134人中的87人]髋)。我们进行了全面的记录回顾,以确定症状性静脉血栓栓塞的发生率,包括远端DVT、近端DVT或肺栓塞。比较两组患者的人口统计学、手术细节和结果。高位骑行组手术时间较长,术后接受全身麻醉、髋臼骨移植、输血或限制负重的患者比例较高。采用单变量分析比较高骑DDH组与对照组,并评估潜在危险因素与症状性静脉血栓栓塞之间的关系。随后进行多变量logistic回归,在单变量分析中确定的变量中找出独立的危险因素。结果与对照组相比,接受THA治疗DDH的患者出现症状性静脉血栓栓塞的几率更高(17%[47 / 8]对1% [87 / 1],OR为18[95%可信区间(CI) 2至146];P = 0.001)。在校正了年龄、性别、美国麻醉医师学会分级、麻醉类型、手术时间、缩短截骨术、支架/嵌塞移植术和输血等混杂变量后,接受THA治疗高位DDH的患者发生症状性静脉血栓栓塞的调整几率仍高于另一组(调整OR为67 [95% CI 3 ~ 151];P = 0.008)。当仅考虑近端DVT或肺栓塞事件(不包括远端DVT)时,与其他组相比,高度DDH患者发生VTE事件的几率仍然更高(11%[47 / 5]对1% [87 / 1],or 10 [95% CI 1至90];P = 0.02)。在因高位DDH而接受THA的患者中,在控制了潜在的混杂变量后,肢体延长被确定为与症状性静脉血栓栓塞可能性增加相关的唯一因素(中位[范围]延长38毫米[25至60]对25毫米[15至50];P = 0.002)。结论:我们的研究结果表明,与因其他适应症而接受原发性THA的患者相比,因高度发育性DDH接受THA并接受阿司匹林预防静脉血栓栓塞的患者发生症状性静脉血栓栓塞(包括DVT和肺栓塞)的可能性更高。此外,术中肢体加长似乎进一步增加了静脉血栓栓塞的风险。虽然DDH可能是THA后症状性静脉血栓栓塞的危险因素,但这种关联也可能归因于高位DDH髋部手术的复杂性增加。 在对潜在危险因素进行多变量分析的更大规模研究来澄清这一问题之前,我们建议外科医生考虑使用比阿司匹林更有效的血栓预防药物来治疗因高位DDH而接受THA治疗的患者,并在术后对静脉血栓栓塞的体征和症状保持特别警惕。证据等级:III级,治疗性研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
High Risk of Venous Thromboembolism With Aspirin Prophylaxis After THA for High-riding Developmental Dysplasia of the Hip: A Retrospective, Comparative Study.
BACKGROUND Despite advancements, THA is still associated with risks, particularly venous thromboembolism (VTE). THA in patients with high-riding developmental dysplasia of the hip (DDH) could potentially be associated with an elevated risk of VTE. We conducted a study to evaluate whether patients with high-riding DDH undergoing THA and receiving aspirin have an increased risk of symptomatic VTE compared with patients undergoing primary THA for other diagnoses. Additionally, we investigated possible risk factors for VTE within this specific patient group. QUESTIONS/PURPOSES (1) Is the risk of symptomatic VTE (all deep vein thrombosis [DVT] plus pulmonary embolism, or proximal DVT plus pulmonary embolism) increased in patients undergoing THA for severe DDH, defined as Crowe type III or IV, compared with patients undergoing THA for other reasons when aspirin is used for prophylaxis? (2) In patients with severe DDH undergoing THA, are there specific identifiable risk factors associated with an increased risk of symptomatic VTE? METHODS Between June and November 2021, an arthroplasty surgeon performed 153 consecutive primary THAs on 146 patients across two arthroplasty centers. All patients except those with a history of prior VTE or those on chronic anticoagulation received aspirin as pharmacologic prophylaxis for VTE. No routine surveillance for VTE was used. To be eligible for this retrospective comparative study, a chart note documenting any signs or symptoms of symptomatic VTE had to be present at least 3 months postoperatively. Patients were excluded for the following reasons: they had a personal history of VTE (1% [2 of 146]), they were receiving ongoing anticoagulant therapy (2% [3 of 146]), they were out of the age criteria range (2% [3 of 146]), they had undergone same-setting bilateral THAs or the second side of staged bilateral THAs (3% [4 of 146]), or they were lost to follow-up within 90 days after surgery (0% [0]). After exclusions, 134 patients (134 hips) remained. Patients were divided into two groups based on their preoperative diagnosis: (1) high-riding DDH of Crowe type III or IV (35% [47 of 134] of hips) and (2) all other diagnoses, including primary or inflammatory arthritis, Crowe type I or II DDH, fracture, and osteonecrosis (65% [87 of 134] of hips). A comprehensive records review was conducted to determine the incidence of symptomatic VTE, including distal DVT, proximal DVT, or pulmonary embolism. Patients' demographics, surgical details, and outcomes were compared between the groups. The high-riding group had longer operations and a higher percentage of patients having general anesthesia, acetabular bone grafting, transfusions, or restricted weightbearing postoperatively. Univariable analysis was performed to compare the high-riding DDH group with the control group and to evaluate associations between potential risk factors and symptomatic VTE. Subsequently, multivariable logistic regression was conducted to identify independent risk factors among the variables identified in the univariable analysis. RESULTS Patients undergoing THA for DDH had higher odds of experiencing symptomatic VTE compared with the control group (17% [8 of 47] versus 1% [1 of 87], OR 18 [95% confidence interval (CI) 2 to 146]; p = 0.001). After adjusting for confounding variables such as age, sex, American Society of Anesthesiologists grading, anesthesia type, operation duration, shortening osteotomy, shelf/impaction grafting, and blood transfusion, patients undergoing THA for high-riding DDH still had higher adjusted odds of symptomatic VTE compared with the other group (adjusted OR 67 [95% CI 3 to 151]; p = 0.008). When considering only proximal DVT or pulmonary embolism events (excluding distal DVT), the odds of experiencing a VTE event remained higher in patients with high-riding DDH compared with the other group (11% [5 of 47] versus 1% [1 of 87], OR 10 [95% CI 1 to 90]; p = 0.02). In patients undergoing THA for high-riding DDH, after controlling for potential confounding variables, limb lengthening was identified as the only factor associated with an increased likelihood of symptomatic VTE (median [range] lengthening 38 mm [25 to 60] versus 25 mm [15 to 50]; p = 0.002). CONCLUSION Our findings showed that patients undergoing THA for high-riding developmental DDH and receiving aspirin for VTE prophylaxis had a higher likelihood of experiencing symptomatic VTE, including DVT and pulmonary embolism, compared with patients undergoing primary THA for other indications. Additionally, greater intraoperative limb lengthening in this group appeared to further increase the risk of VTE. While DDH may be a risk factor for symptomatic VTE after THA, this association could also be attributed to the increased complexity of the procedure in hips with high-riding DDH. Until larger studies with multivariable analyses of potential risk factors are conducted to clarify this issue, we recommend that surgeons consider using thromboprophylaxis agents more potent than aspirin for patients undergoing THA for high-riding DDH and remain particularly vigilant in the postoperative period for signs and symptoms of VTE. LEVEL OF EVIDENCE Level III, therapeutic study.
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来源期刊
CiteScore
7.00
自引率
11.90%
发文量
722
审稿时长
2.5 months
期刊介绍: Clinical Orthopaedics and Related Research® is a leading peer-reviewed journal devoted to the dissemination of new and important orthopaedic knowledge. CORR® brings readers the latest clinical and basic research, along with columns, commentaries, and interviews with authors.
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