Aspirin對某些TKA病患可能是預防VTE最好的選擇


  March 7, 2008(舊金山訊)-根據一項檢驗aspirin使用於這些病患潛在角色的研究結果,對於接受骨科手術的病患而言,aspirin可能是預防肺部栓塞(PE)與靜脈栓塞(VTE)最有效的選擇。
  
  Aspirin目前並沒有被美國胸腔醫學會建議用於預防手術後的深部靜脈栓塞(DVT),然而,美國骨外科學會(AAOS)已經發表另一個預防PE與VTE的治療指引,該指引在臨床上與骨外科醫師較相關;AAOS指引建議使用aspirin來預防DVT風險較低或是高出血風險病患發生PE與VTE。
  
  一項收集2003年到2005年,於全國各地307家醫院收納93,840位接受全膝關節鏡(TKA)病患的回溯性研究,這項研究針對aspirin預防VTE的效果;這項研究結果發表於AAOS第75屆年會中,由Kevin J. Bozic醫師,他是舊金山加州大學Philip R. Lee健康政策研究機構與骨外科部門的助理教授。
  
  Bozic醫師在發表會中表示,TKA在近年來有許多改變,降低了VTE的風險,因此,使用aspirin來預防VTE的經濟效益也已經改變;他在新聞稿中表示,目前接受膝蓋手術的病患比治療指引發表時來的年輕且較健康。
  
  在這項研究中,Bozic醫師分析主要接受TKA病患的數據,且評估VTE、出血事件、外科部位感染、與死亡率,總共有4,719位病患(5%)接受aspirin作為化學預防;接受aspirin的病患,相較於接受warfarin的病患(513923位病患[55%])、或注射型VTEP(37,198位[40%])的VTE風險指數較低;整體而言,接受aspirin預防的病患好得比其他病患快,住院時間較短、且直接出院回家的比例較高;三組之間的校正後出血與死亡風險是差不多的,但使用aspirin病患比使用warfarin病患較不容易發生VTE。
  
  在他的發表會中,Bozic醫師表示,使用aspirin的病患接下來使用加壓裝置的情況比高風險病患少;他指出,即使使用aspirin的病患也應需要使用加壓裝置,僅使用aspirin是不適當的,即使是對低風險病患亦然。
  
  Bozic醫師向Medscape骨科學表示,目前已經有研究比較aspirin與其他靜脈栓塞預防藥物的效果,這些研究進行的時候,膝關節置換手術與現在的有許多差異,不論是在照護計畫以及病患的流行病學特徵上;我們的研究結果顯示,在絕大多數病患中,特定族群病患在非常特定的照護流程下,aspirin與其他化學預防藥物一樣有效且安全。
  
  在發表會後,Bozic醫師被問到他是否有針對這些病患使用非類固醇抗發炎藥物(NSAID)的情形進行調查,他表示,他並未調查NSAID使用情形,因為他認為該比例在這三組病患身上並無太大差異。
  
  Bozic醫師向Medscape骨科學表示,現在需要隨機分派研究來進一步瞭解哪些病患與照護流程是適合使用aspirin治療的。
  
  座談會引言人紐澤西Hackensack大學醫學中心骨科主任Michael A. Kelly醫師發現Bozic醫師的研究是非常合理的;Kelly醫師表示,VTE是一個吸引人的課題,因為這對於目前在執業的骨科醫師而言是非常重要的,使用aspirin與之後的加壓裝置可以協助預防他們醫院中低風險單側TKA病患VTE事件,他們發現這項治療對於目前執業中的骨科醫師非常重要。Kelly醫師指出,他在他們的醫院中使用aspirin與接下來的加壓裝置幫助低風險單側TKA病患預防VTE,他發現這種治療可以有效地預防與VTE有關的問題。
  
  Bozic醫師與共同作者接受加州健康照護系統骨科研究與教育基金的研究經費,以及健康照護研究與品質的病患安全研究與訓練經費。

Aspirin May Be Best to Prevent

By Laurie Bouck
Medscape Medical News

Laurie Bouck

March 7, 2008 (San Francisco) — Aspirin may be the most effective choice to prevent pulmonary embolism (PE) and venous thromboembolism (VTE) in patients undergoing orthopaedic surgery, according to a new study examining a potential role for aspirin in these patients.

Aspirin is not currently recommended by the American College of Chest Physicians to help prevent deep vein thrombosis (DVT) after surgery. The American Academy of Orthopaedic Surgeons (AAOS), however, has developed separate guidelines to prevent PE and VTE that are more clinically relevant to orthopaedic surgeons. The AAOS guidelines recommend aspirin to prevent PE and VTE in patients with a low risk of DVT or a higher risk of bleeding.

A 2003 to 2005 retrospective study of 93,840 total knee arthroscopy (TKA) patients at 307 hospitals nationwide looked at aspirin's effect on VTE. The study was presented here at the AAOS 75th Annual Meeting by lead investigator Kevin J. Bozic, MD, MBA, associate professor in residence at the Department of Orthopaedic Surgery and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.

Many aspects of TKA have changed in recent years, lowering the risk of VTE, Dr. Bozic said during his presentation, and as a result, "The risk-benefit balance of aspirin has shifted." He adds in a press release that "patients undergoing knee surgery today are more likely to be younger and healthier than when the current treatment guidelines were developed."

In his study, Dr. Bozic analyzed administrative data for primary TKA patients and measured VTE, bleeding events, surgical site infections, and mortality. A total of 4719 patients (5%) received aspirin as a chemoprophylactic. Patients who received aspirin had a lower VTE risk score than the patients who received warfarin (51,923 patients [55%]) or injectable VTEP (37,198 patients [40%]). On average, patients who received aspirin recovered more quickly than other patients, with a shorter hospital stay and more discharges directly home. Adjusted bleeding and mortality risks were similar among all 3 groups, but aspirin patients were less likely to develop VTE than warfarin patients.

In his presentation, Dr. Bozic said that the patients who received aspirin had a much lower use of sequential compression devices than high-risk patients. He pointed out that even aspirin patients should receive sequential compression as needed. "Aspirin alone is not indicated, even in low-risk patients," he said.

"There have been trials comparing aspirin to other venous thromboembolic prophylactic agents," Dr. Bozic told Medscape Orthopaedics. "Those were done in an era where knee replacement surgery was practiced very differently than it is today, in terms of the care protocols and in terms of the patient demographics. What our study shows, in a very large population of patients, is that aspirin as it is being used in clinical practice today, in a certain subset of patients under very specific care pathways, is as effective and as safe as other chemoprophylactic agents."

After the presentation, Dr. Bozic was asked whether he looked at nonsteroidal anti-inflammatory drug (NSAID) use among the patients. He said that he did not look at NSAID use because he thought that it probably did not vary across the 3 groups of patients.

Dr. Bozic told Medscape Orthopaedics that randomized controlled trials are now needed to better understand which patients and care pathways are appropriate for aspirin therapy.

Session moderator Michael A. Kelly, MD, chair of Orthopaedics at Hackensack University Medical Center, New Jersey, found Dr. Bozic's study "very reasonable." Dr. Kelly said that VTE is "an interesting topic because these issues are very critical to the orthopaedists who practice now." Dr. Kelly said that he uses aspirin and sequential compression devices to help prevent VTE in the low-risk, unilateral TKA patients at his hospital, a therapy that he found "quite efficacious for preventing catastrophic problems related to DVT."

Dr. Bozic and coauthors received research grants from the Orthopaedic Research and Education Foundation, the California Healthcare Foundation, and a patient safety research and training grant from the Agency for Healthcare Research and Quality.

American Academy of Orthopaedic Surgeons 75th Annual Meeting: Abstract. Presented March 5, 2008.

    
相關報導
腹部手術後皮下注射肝素吸收不佳
2011/1/24 上午 10:23:00
年長女性使用低劑量Aspirin相關消化性潰瘍風險較高
2010/5/6 下午 05:21:00
單一劑量的Aspirin可以有效緩解偏頭痛
2010/4/22 下午 04:52:00

上一頁
   1   2   3   4   5   6   7  




回上一頁