背景:全髋关节置换术(THA)是一种常见的手术,需要考虑先前存在的合并症。因子V莱顿(FVL),遗传性血栓形成倾向,是一种使患者容易发生静脉血栓栓塞(VTE,深静脉血栓形成[DVT],和肺栓塞[PE])。本研究旨在表征与接受THA的FVL患者相关的风险,并评估VTE化学预防剂对这些风险的影响。
方法:在行政索赔数据库中确定了在2010年至2021年10月期间接受原发性THA治疗的成年患者。其中,在1,138(0.21%)中鉴定出FVL。有和没有FVL的患者根据年龄以1:4的比例匹配(1,131有FVL和4,519没有FVL),性别,和Elixhauser合并症指数。对90天并发症进行单变量和多变量分析。评估了5年时的植入物存活率,并与对数秩检验进行了比较。不同化学预防剂的相对使用,包括阿司匹林,华法林,肝素,或直接口服抗凝剂(DOAC),被评估。比较阿司匹林或华法林处方的出血事件和VTE,肝素,或DOAC。应用Bonferroni校正。
结果:关于多变量分析,发现FVL患者90天DVT的几率增加(比值比(OR)=9.20),PE(OR=6.89),和汇总的严重和所有不良事件(OR分别为4.74和1.98),但未增加其他围手术期不良事件或5年再手术的风险。更有效的化学预防剂(华法林,肝素,DOAC)减少,但并没有完全消除,VTE风险增加(未增加出血事件).
结论:本研究量化了与接受THA的FVL患者相关的显著升高的VTE风险。其他具体不良事件和五年的再手术缺乏差异令人放心。显然,化学预防剂在该人群中很重要,可能需要进一步关注。
BACKGROUND: Total hip arthroplasty (THA) is a common procedure that requires consideration of preexisting comorbidities. Factor V Leiden (FVL), an inherited thrombophilia, is one such condition that predisposes patients to venous thromboembolism (VTE, deep vein thrombosis, and pulmonary embolism). The present study aimed to characterize the risks associated with FVL patients undergoing THA and evaluate the effect of VTE chemoprophylactic agents on these risks.
METHODS: A total of 544,022 adult patients who underwent primary THA for osteoarthritis indications between 2010 and October 2021 were identified in an administrative claims database. Of these, FVL was identified in 1,138 (0.21%). Patients who had and did not have FVL were matched at a 1:4 ratio (1,131 with FVL and 4,519 without FVL) based on age, sex, and Elixhauser comorbidity index. Univariable and multivariable analyses were assessed for 90-day complications. Implant survival at 5 years was assessed and compared with log-rank tests. The relative use of different chemoprophylactic agents, including aspirin, warfarin, heparin, or direct oral anticoagulant (DOAC), was assessed. Bleeding events and VTE were compared for those prescribed either aspirin or warfarin, heparin, or DOAC. A Bonferroni correction was applied.
RESULTS: On multivariable analysis, FVL patients were found to have increased odds of 90-day deep vein thrombosis (odds ratio (OR) = 9.20), pulmonary embolism (OR = 6.89), and aggregated severe and all adverse events (OR = 4.74 and 1.98, respectively), but not elevated risk of other perioperative adverse events or 5-year reoperations. More potent chemoprophylactic agents (warfarin, heparin, DOAC) reduced, but did not completely eliminate, the increased VTE risks (without increasing bleeding events).
CONCLUSIONS: This study quantified the significantly elevated VTE risk associated with FVL patients undergoing THA. The lack of difference in other specific adverse events and 5-year reoperations is reassuring. Clearly, chemoprophylactic agents are important in this population and may need further attention.