A Prospective Comparison of Warfarin to Aspirin for Thromboprophylaxis in Total Hip and Total Knee Arthroplasty

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• 作者：Intermountain Joint Replacement Center Writing Committee
• 关键词：venous thromboembolism ; pulmonary embolism ; total knee ; total hip ; arthroplasty ; American Academy of Orthopaedic Surgeons ; American College of Chest Physicians ; guidelines
• 刊名：The Journal of Arthroplasty
• 出版年：2012
• 出版时间：January 2012
• 年：2012
• 卷：27
• 期：1
• 页码：1-9.e2
• 全文大小：592 K

文摘

Current orthopedic practice requires consideration of contradictory recommendations regarding pulmonary embolism (PE) prevention among patients undergoing total hip arthroplasty (THA) and knee joint arthroplasty (TKA). A total of 696 consecutive patients underwent elective THA or TKA. Two hundred eighty-one patients received PE risk stratification per American Academy of Orthopaedic Surgeons guidelines. Of these patients, 152 standard-risk patients received aspirin, and 129 elevated-risk patients received warfarin. The comparator group of 415 patients received American College of Chest Physicians¨Crecommended warfarin without PE risk stratification. Primary study outcomes were symptomatic PE, deep venous thrombosis, major bleeding, and death. The rate of symptomatic PE and venous thromboembolism among standard-risk group patients receiving aspirin was greater than the comparator group (4.6 % vs 0.7 % and 7.9 % vs 1.2 % , respectively). Most events (16/18) occurred among patients undergoing TKA. Patients with total joint arthroplasty at standard risk for PE receiving aspirin had a higher rate of symptomatic PE and venous thromboembolism than did patients receiving anticoagulation.