老年髋膝关节置换术后静脉血栓栓塞与出血风险评估及其相关因素分析

Risk assessment and analysis of related factors for venous thromboembolism and bleeding after hip and knee replacement in elderly patients

目的评估阿司匹林和新型口服抗凝药物(NOACs)在老年髋膝关节置换术后预防静脉血栓栓塞(VTE)和出血事件的效果,并分析相关的危险因素。方法本研究为回顾性队列研究,连续纳入2018年1月至2022年12月于广西科技大学第一附属医院进行髋膝关节置换术的1032例老年患者,根据抗凝治疗方案分为阿司匹林组(674例)和NOACs组(358例),并通过倾向评分匹配(PSM)方法按1∶1匹配基线资料,最终纳入652例患者,分别为阿司匹林组(326例)和NOACs组(326例)。主要观察指标为术后90 d内的VTE事件和出血事件。使用Cox比例风险回归模型分析危险因素。结果PSM匹配前后,2组患者的基线资料和VTE事件发生率比较差异均无统计学意义(均P>0.05)。PSM匹配前后,NOACs组出血事件发生率均低于阿司匹林组[6.1%(22/358)比8.0%(54/674),4.9%(16/326)比8.3%(27/326)],差异均有统计学意义(均P<0.05)。Cox回归模型分析结果显示男性、膝关节置换、慢性肾脏病、既往VTE病史和抗心磷脂抗体或狼疮抗凝物均是VTE事件的显著危险因素(均P<0.05),年龄、肿瘤、慢性肾脏病和住院时间均是出血事件的显著危险因素(均P<0.05)。结论阿司匹林和NOACs在老年髋膝关节置换术后预防VTE方面的效果相似,阿司匹林治疗的出血风险较高。男性、膝关节置换、慢性肾脏病、既往VTE病史和抗心磷脂抗体或狼疮抗凝物是VTE的主要危险因素,而年龄、肿瘤、慢性肾脏病和住院时间是出血事件的主要危险因素。

Objective To evaluate the efficacy of aspirin and new oral anticoagulants(NOACs)in the prevention of venous thromboembolism(VTE)and bleeding events after hip and knee arthroplasty in the elderly,and to analyze the related risk factors.Methods This study was a retrospective cohort study.A total of 1032 elderly patients who underwent hip and knee arthroplasty in the First Affiliated Hospital of Guangxi University of Science and Technology from January 2018 to December 2022 were consecutively enrolled.According to the anticoagulant therapy regimen,the patients were divided into aspirin group(674 cases)and NOACs group(358 cases).The baseline data were matched 1∶1 by propensity score matching(PSM)method.Finally,a total of 652 patients were enrolled and divided into aspirin group(326 cases)and NOACs group(326 cases).The main outcome measures were VTE events and bleeding events within 90 d after surgery.Cox proportional hazards regression model was used to analyze the risk factors.Results There were no significant differences in baseline data and incidence of VTE events between the two groups before and after PSM matching(all P>0.05).Before and after PSM matching,the incidence of bleeding events in the NOACs group was lower than that in the aspirin group[6.1%(22/358)vs 8.0%(54/674),4.9%(16/326)vs 8.3%(27/326)](all P<0.05).Cox regression model analysis showed that male,knee replacement,chronic kidney disease,previous history of VTE,and anticardiolipin antibodies or lupus anticoagulant were significant risk factors for VTE events(all P<0.05).Age,cancer,chronic kidney disease,and length of hospital stay were all significant risk factors for bleeding events(all P<0.05).Conclusions Aspirin and NOACs have similar efficacy in preventing VTE after hip and knee arthroplasty in the elderly,and aspirin therapy has a higher risk of bleeding.Male sex,knee replacement,chronic kidney disease,previous history of VTE,and anticardiolipin antibodies or lupus anticoagulant are the main risk factors for VTE,while age,cancer,chronic kidney disease,and length of hospital stay are the main risk factors for bleeding events.