目的:许多指南指出,持续使用抗凝药物可降低静脉血栓(VT)的发生率,但没有研究显示对全膝关节置换术(TKA)患者出院后症状性静脉血栓(SVT)发生率的影响。本研究旨在探讨TKA患者出院后是否需要应用抗凝剂。
方法:符合排除标准要求的患者,由同一手术团队进行TKA,手术后接受抗凝治疗符合研究条件.最后,共纳入567例TKA患者作为参与者.将患者分为两组。A组患者术后服用低分子肝素5~10d,其中包括但不限于低分子量肝素钙注射液(0.4mL,ih,Qd),二恶英钙注射液(0.6毫升,ih,Qd),或依诺肝素钠注射液(0.4mL,ih,Qd),患者需要继续口服抗凝药(10毫克,po,Qd)出院后7-21天。B组患者术后5~10天仅服用低分子肝素,出院后不治疗。患者的基线特征,SVT的总并发症包括下肢血管疼痛(LLVP),下肢血管疼痛无溃烂(LLVPNF),下肢肿胀(LLS),下肢溃烂(LLF),和血栓形成(DT)死亡,比较两组患者出院后的出血量和死亡率。
结果:研究表明,SVT患者的发生率在两组之间没有显着差异(p=0.489)。此外,LLVP的发生率(p=0.265),LLS(p=0.84),LLVPNF(p=0.213),LLF(p=0.907),DT(p=0.907),其他原因死亡,两组之间的出血(p=0.323)没有显着差异。然而,吸烟(p=0.0001或0.0011)或饮酒(p=0.0002或0.0001)患者的SVT发生率显著增加.
结论:没有足够的证据表明TKA患者出院后给予抗凝药物对降低SVT风险有益处。此外,吸烟和饮酒会显著增加TKA患者发生SVT的风险.
OBJECTIVE: Many guidelines indicate that continuous use of anticoagulant drugs reduces the incidence of venous thrombus (VT), but no studies show the effect on the incidence of symptomatic venous thrombus (SVT) in total knee arthroplasty (TKA) patients after discharge. This study aimed to investigate whether it is necessary to apply anticoagulants to TKA patients after discharge.
METHODS: Patients who met the exclusion criteria requirement, underwent TKA by the same surgical team and received anticoagulant therapy after the operation were eligible for the study. Finally, a total of 567 TKA patients were recruited as participants. The patients were divided into two groups. The patients in group A were taken low molecular heparin for 5-10 days after surgery, which included but was not limited to low molecular weight heparin calcium injection (0.4 mL, ih, Qd), calcium dioxin injection (0.6 mL, ih, Qd), or enoxaparin sodium injection (0.4 mL, ih, Qd), and the patients needed to continue oral anticoagulant drug (10 mg, po, Qd) for 7-21 days after discharge. The patients in group B only took low molecular heparin 5-10 days after surgery and no treatment after discharge. The baseline characteristics of patients, total complications of SVT include lower limb vascular pain (LLVP), lower limb vascular pain no fester (LLVPNF), lower limbs swelling (LLS), lower limb fester (LLF), and death by thrombosis (DT), bleeding and mortality following discharged were compared between two groups.
RESULTS: The study showed that the incidence of SVT patients had no significant difference between the two groups (p = 0.489). Moreover, the incidence of LLVP (p = 0.265), LLS (p = 0.84), LLVPNF (p = 0.213), LLF (p = 0.907), DT (p = 0.907), death from other causes, and bleeding (p = 0.323) had no significant differences between the two groups. However, the incidence of SVT in patients with smoking (p = 0.0001 or 0.0011) or drinking (p = 0.0002 or 0.0001) was significantly increased.
CONCLUSIONS: There is not enough evidence showing that the TKA patients given anticoagulants after discharge had benefits in decreasing the risk of SVT. Furthermore, smoking and drinking would significantly increase the risk of SVT in TKA patients.