阿司匹林预防关节置换术后血栓栓塞性疾病的疗效和安全性研究

Efficacy and safety of aspirin in prevention of venous thromboembolism after total joint arthroplasty

目的探讨阿司匹林对预防人工关节置换术后静脉血栓的疗效和安全性。方法回顾行全膝和全髋关节置换的240例患者。其中全膝关节置换157例,全髋关节置换83例。分为两组,甲组100例,于术后第1天起给予阿司匹林抗凝;乙组140例,给予低分子肝素抗凝。通过观察比较下肢深静脉血栓、肺栓塞、心脑血管意外的发生率和出血、感染的发生情况,评价阿司匹林在人工关节置换术后预防血栓栓塞性疾病的疗效和安全性。结果甲组使用阿司匹林术后出现深静脉血栓13例(13.0%),有症状深静脉血栓7例(7.0%),疑诊肺栓塞3例(3%),心脑血管意外2例(2%);乙组出现深静脉血栓、有症状的深静脉血栓、疑诊肺栓塞和心脑血管事件分别为10例(7.1%),4例(2.9%),3例(2.1%),8例(5.7%),两组差异均无统计学意义(P 值分别为0.129、0.130、0.675、0.156)。阿司匹林组术后出血量、血红蛋白下降量、血肿发生率、感染发生率分别是(693±480)ml、(32.9±18.0)g/L、1例(1%)、0例(0%),LMWH 组分别是(649±521)ml、(36.4±21.9)g/L、3例(2.1%)、2例(1.4%),两组之间差异均无统计学意义(P 值分别为0.501、0.177、0.495、0.230)。结论阿司匹林和低分子肝素对关节置换术后静脉血栓栓塞疾病的预防疗效相近,出血和感染风险无明显区别。阿司匹林口服给药方便、费用低、患者依从性好、无需监测并对术后心脑血管事件有良好的预防作用。阿司匹林可作为人工关节置换术后预防静脉血栓常规方案之一。

Objective To study the efficacy and safety of aspirin in prophylaxis of venous thromboembolism （VTE） after total joint arthroplasty. Methods 240 patients who received total joint arthroplasty, 157 undergoing total knee arthroplasty （TKA） and 83 undergoing total hip arthroplasty （THR） , were divided into 2 basically matched groups, Group A （n = 100） , receiving aspirin enteric-coated tablets 100 mg/day since the first day after operation till discharge 10 - 14 days after operation, and Group B （n = 140） , receiving subcutaneous injection of low molecular weight heparin （LMWH） once daily for 10 d. The effects and safety were evaluated. Results 13 patients （ 13.0% ） were diagnosed with deep venous thrombosis （DVT） in Group A, 7 of them were symptomatic, 3 were suspected of pulmonary embolism, and 2 suffered from cardio-cerebrovascular event. In Group B, 10 patients （7. 1% ） had DVT, 4 of them were symptomatic; suspicious pulmonary embolism and cardio-cerebrovascular event were diagnosed in 3 and 8 patients respectively. There were no statistic significances between the two groups in all these aspects. The quantity of bleeding, decrease of hemoglobin, hematoma rate, and infection rate of Group A were （693. 4 ± 480. 1） ml, （32.9 ±18.0） g/L,1%, and 0% respectively, all not significantly different from those of Group B （648.9 ±521.1） ml, （36.4±21.9） g/L, 2. 1%, and 1.4% respectively, all P 〉 0. 05. Conclusion Aspirin is as effective as LMWH in venous thromboembolism prophylaxis after total joint arthroplasty. In addition, aspirin is cheap, administered orally, well tolerated, without necessity for surveillance, and with good compliance and potential of prevention of cardio-cerebrovascular events.