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下肢大关节手术围手术期抗凝治疗

曲哲 吴志宏 郭开今

曲哲, 吴志宏, 郭开今. 下肢大关节手术围手术期抗凝治疗[J]. 协和医学杂志, 2019, 10(6): 633-638. doi: 10.3969/j.issn.1674-9081.2019.06.015
引用本文: 曲哲, 吴志宏, 郭开今. 下肢大关节手术围手术期抗凝治疗[J]. 协和医学杂志, 2019, 10(6): 633-638. doi: 10.3969/j.issn.1674-9081.2019.06.015
Zhe QU, Zhi-hong WU, Kai-jin GUO. Anticoagulant Therapy for Perioperative Management of Major Lower Limb Joint Surgery[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(6): 633-638. doi: 10.3969/j.issn.1674-9081.2019.06.015
Citation: Zhe QU, Zhi-hong WU, Kai-jin GUO. Anticoagulant Therapy for Perioperative Management of Major Lower Limb Joint Surgery[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(6): 633-638. doi: 10.3969/j.issn.1674-9081.2019.06.015

下肢大关节手术围手术期抗凝治疗

doi: 10.3969/j.issn.1674-9081.2019.06.015
详细信息
    通讯作者:

    郭开今 电话:0516-85609999, E-mail:xzgkj@sina.com

  • 中图分类号: R619+.2

Anticoagulant Therapy for Perioperative Management of Major Lower Limb Joint Surgery

More Information
    Corresponding author: Guo Kai-jin Tel: 86-0516-85609999, E-mail:xzgkj@sina.com
  • 摘要: 静脉血栓栓塞症(venous thromboembolism, VTE)包括深静脉血栓形成和肺血栓栓塞症, 是下肢大关节手术后发生率高且后果严重的并发症, 因此术后抗凝治疗预防VTE受到越来越多骨科医师的重视。随着国内外抗凝治疗指南的推广应用, 下肢大关节手术后VTE发生风险及死亡率明显降低, 对此类患者术后常规抗凝治疗已成为骨科医师共识; 然而, 目前对于具体抗凝方案及疗程选择, 是否需要联合用药, 以及对合并复杂基础疾病患者的围手术期抗凝等问题仍有争议。本文对下肢大关节手术围手术期常用抗凝药物、抗凝方案、抗凝风险和并发症以及复杂情况下的抗凝治疗进行阐述。
    利益冲突  无
  • [1] Charen DA, Qian ET, Hutzler LH, et al. Risk factors for postoperative venous thromboembolism in orthopaedic spine surgery, hip arthroplasty, and knee arthroplasty patients[J]. Bull Hosp Jt Dis, 2015, 73:198-203. http://smartsearch.nstl.gov.cn/paper_detail.html?id=f5d6c201cf12773cfe67658d7c3682f9
    [2] Zhang ZH, Shen B, Yang J, et al. Risk factors for venous thromboembolism of total hip arthroplasty and total knee arthroplasty:a systematic review of evidences in ten years[J]. BMC Musculoskelet Disord, 2015, 16:24. http://onlinelibrary.wiley.com/resolve/reference/XREF?id=10.1186/s12891-015-0470-0
    [3] Lieberman JR, Pensak MJ. Prevention of venous thromboembolic disease after total hip and knee arthroplasty[J]. J Bone Joint Surg Am, 2013, 95:1801-1811. https://www.ncbi.nlm.nih.gov/pubmed/24088973
    [4] Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism:the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy[J]. Chest, 2004, 126:338S-400S. http://onlinelibrary.wiley.com/resolve/reference/PMED?id=15383478
    [5] 中华医学会骨科学分会.中国骨科大手术静脉血栓栓塞症预防指南[J].中华骨科杂志, 2009, 29:602-604. http://qikan.cqvip.com/Qikan/Article/Detail?id=30676461
    [6] Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease:antithrombotic therapy and prevention of thrombosis, 9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J]. Chest, 2012, 141:E419S-E496S. http://www.mendeley.com/research/antithrombotic-therapy-vte-disease-antithrombotic-therapy-prevention-thrombosis-9th-ed-american-coll/
    [7] Thirugnanam S, Pinto R, Cook DJ, et al. Economic analyses of venous thromboembolism prevention strategies in hospitalized patients:a systematic review[J]. Crit Care, 2012, 16:R43. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964799/
    [8] Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients:antithrombotic therapy and prevention of thrombosis, 9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J]. Chest, 2012, 141:E278S-E325S. http://cid.oxfordjournals.org/external-ref?access_num=10.1378/chest.11-2296&link_type=DOI
    [9] Johanson NA, Lachiewicz PF, Lieberman JR, et al. American academy of orthopaedic surgeons clinical practice guideline on prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty[J]. J Bone Joint Surg Am, 2009, 91:1756-1757. http://journals.lww.com/jbjsjournal/subjects/Hip/Fulltext/2009/07000/American_Academy_of_Orthopaedic_Surgeons_Clinical.25.aspx
    [10] Mont MA, Jacobs JJ. AAOS clinical practice guideline:preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty[J]. J Am Acad Orthop Surg, 2011, 19:777-778. http://smartsearch.nstl.gov.cn/paper_detail.html?id=92df55ac74158f7034eef3d17e67ac77
    [11] 中华医学会骨科学分会.中国骨科大手术静脉血栓栓塞症预防指南[J].中华骨科杂志, 2016, 2:65-71. http://qikan.cqvip.com/Qikan/Article/Detail?id=30676461
    [12] Geerts W. Prevention of venous thromboembolism:a key patient safety priority[J]. J Thromb Haemost, 2009, 7:1-8. https://www.ncbi.nlm.nih.gov/pubmed/19630756
    [13] 彭慧明, 翁习生, 翟吉良, 等.初次全膝关节成形术后常规抗凝患者症状性静脉血栓症发生率的调查研究[J].中国骨与关节外科, 2014, 2:101-104. http://d.wanfangdata.com.cn/Periodical/zggygjwk201402005
    [14] 王月, 王铁铸, 吕志伟, 等.老年髋部骨折术后下肢深静脉血栓形成的预防[J].中国骨与关节损伤杂志, 2013, 28:137-138. http://www.cnki.com.cn/Article/CJFDTotal-GGJS201302018.htm
    [15] Colwell CW, Collis DK, Paulson R, et al. Comparison of enoxaparin and warfarin for the prevention of venous thromboembolic disease after total hip arthroplasty. Evaluation during hospitalization and three months after discharge[J]. J Bone Joint Surg Am, 1999, 81:932-940. http://europepmc.org/abstract/med/10428124
    [16] Jaff MR. Chronically anticoagulated patients who need surgery:can low-molecular-weight heparins really be used to "bridge" patients instead of intravenous unfractionated heparin?[J]. Catheter Cardiovasc Interv, 2009, 74:S17-S21. doi:  10.1002/ccd.22000/pdf
    [17] Hull R, Raskob G, Pineo G, et al. A comparison of subcutaneous low-molecular-weight heparin with warfarin sodium for prophylaxis against deep-vein thrombosis after hip or knee implantation[J]. N Engl J Med, 1993, 329:1370-1376. http://www.ncbi.nlm.nih.gov/pubmed/8413432/
    [18] Leclerc JR, Geerts WH, Desjardins L, et al. Prevention of venous thromboembolism after knee arthroplasty. A randomized, double-blind trial comparing enoxaparin with warfarin[J]. Ann Intern Med, 1996, 124:619-626. http://europepmc.org/abstract/MED/8607589
    [19] Fitzgerald RH, Spiro TE, Trowbridge AA, et al. Prevention of venous thromboembolic disease following primary total knee arthroplasty. A randomized, multicenter, open-label, parallel-group comparison of enoxaparin and warfarin[J]. J Bone Joint Surg Am, 2001, 83:900-906. http://www.ncbi.nlm.nih.gov/pubmed/11407799
    [20] Eriksson BI, Borris LC, Friedman RJ, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty[J]. N Engl J Med, 2008, 358:2765-2775. http://www.tandfonline.com/servlet/linkout?suffix=CIT0117&dbid=16&doi=10.1185%2F03007995.2014.949647&key=10.1056%2FNEJMoa076016
    [21] Turpie AG, Lassen MR, Davidson BL, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4):a randomised trial[J]. Lancet, 2009, 373:1673-1680. https://www.sciencedirect.com/science/article/pii/S0140673609607340
    [22] Lassen MR, Raskob GE, Gallus A, et al. Apixaban or enoxaparin for thromboprophylaxis after knee replacement[J]. N Engl J Med, 2009, 361:594-604. http://www.ncbi.nlm.nih.gov/pubmed/19923583
    [23] Feng W, Wu K, Liu Z, et al. Oral direct factor Xa inhibitor versus enoxaparin for thromboprophylaxis after hip or knee arthroplasty:systemic review, traditional meta-analysis, dose-response meta-analysis and network meta-analysis[J]. Thromb Res, 2015, 136:1133-1144. doi:  10.1016/j.thromres.2015.10.009
    [24] Eriksson BI, Dahl OE, Rosencher N, et al. Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement:a randomised, double-blind, non-inferiority trial[J]. Lancet, 2007, 370:949-956. http://www.sciencedirect.com/science/article/pii/S0140673607614457
    [25] Ginsberg JS, Davidson BL, Comp PC, et al. Oral thrombin inhibitor dabigatran etexilate vs North American enoxaparin regimen for prevention of venous thromboembolism after knee arthroplasty surgery[J]. J Arthroplasty, 2009, 24:1-9. https://pubmed.ncbi.nlm.nih.gov/18534438/
    [26] Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: pulmonary embolism prevention (PEP) trial[J]. Lancet, 2000, 355: 1295-1302.
    [27] Chu JN, Maselli J, Auerbach AD, et al. The risk of venous thromboembolism with aspirin compared to anticoagulants after hip and knee arthroplasty[J]. Thromb Res, 2017, 155:65-71. http://smartsearch.nstl.gov.cn/paper_detail.html?id=14f3dabeb063b863a83fb993a43c3bc7
    [28] Kulshrestha V, Kumar S. DVT prophylaxis after TKA:routine anticoagulation vs risk screening approach-a randomized study[J]. J Arthroplasty, 2013, 28:1868-1873. https://www.sciencedirect.com/science/article/pii/S0883540313004051
    [29] Garfinkel JH, Gladnick BP, Roland N, et al. Increased incidence of bleeding and wound complications eith factor-Xa inhibitors after total joint arthroplasty[J]. J Arthroplasty, 2017, 17:S0883-5403. http://europepmc.org/abstract/MED/28947374
    [30] Tang Y, Wang K, Shi Z, et al. A RCT study of Rivaroxaban, low-molecular-weight heparin, and sequential medication regimens for the prevention of venous thrombosis after internal fixation of hip fracture[J]. Biomed Pharmacother, 2017, 92:982-988. http://www.ncbi.nlm.nih.gov/pubmed/28605879
    [31] McDougall CJ, Gray HS, Simpson PM, et al. Complications related to therapeutic anticoagulation in total hip arthroplasty[J]. J Arthroplasty, 2013, 28:187-192. http://www.sciencedirect.com/science/article/pii/S088354031200352X
    [32] Forster R, Stewart M. Anticoagulants (extended duration) for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair[J]. Cochrane Database Syst Rev, 2016, 3:CD004179. doi:  10.1002/14651858.CD004179.pub2/full
    [33] Krishnaswamy A, Lincoff AM, Cannon CP. Bleeding complications of unfractionated heparin[J]. Expert Opin Drug Saf, 2011, 10:77-84.
    [34] Nieto JA, Espada NG, Merino RG, et al. Dabigatran, rivaroxaban and apixaban versus enoxaparin for thombopro-phylaxis after total knee or hip arthroplasty:pool-analysis of phaseⅢ randomized clinical trials[J]. Thromb Res, 2012, 130:183-191.
    [35] Jensen CD, Steval A, Partington PF, et al. Return to theatre following total hip and knee replacement, before and after the introduction of rivaroxaban:a retrospective cohort study[J]. J Bone Joint Surg Br, 2011, 93:91-95. https://www.ncbi.nlm.nih.gov/pubmed/21196550
    [36] Ufer M. Comparative efficacy and safety of the novel oral anticoagulants dabigatran, rivaroxaban and apixaban in pre-clinical and clinical development[J]. Thromb Haemost, 2010, 103:572-585. https://reference.medscape.com/medline/abstract/20135071
    [37] Agaba P, Kildow BJ, Dhotar H, et al. Comparison of postoperative complications after total hip arthroplasty among patients receiving aspirin, enoxaparin, warfarin, and factor Xa inhibitors[J]. J Orthop, 2017, 14:537-543. https://www.sciencedirect.com/science/article/pii/S0972978X17302040
    [38] 岳辰, 周宗科, 裴福兴, 等.中国髋、膝关节置换术围术期抗纤溶药序贯抗凝血药应用方案的专家共识[J].中华骨与关节外科杂志, 2015, 8:281-285.
    [39] Duncan CM, Gillette BP, Jacob AK, et al. Venous thromboembolism and mortality associated with tranexamic acid use during total hip and knee arthroplasty[J]. J Arthroplasty, 2015, 30:272-276.
    [40] Martel N, Lee J, Wells PS. Risk for heparin-induced thrombocytopenia with unfractionated and low-molecular-weight heparin thromboprophylaxis:a meta-analysis[J]. Blood, 2005, 106:2710-2715. https://pubmed.ncbi.nlm.nih.gov/15985543/
    [41] Nazarian RM, Van Cott EM, Zembowicz A, et al. Warfarin-induced skin necrosis[J]. J Am Acad Dermatol, 2009, 61:325-332. https://www.ncbi.nlm.nih.gov/pubmed/19615543
    [42] Lefkou E, Khamashta M, Hampson G, et al. Review:Low-molecular-weight heparin-induced osteoporosis and osteoporotic fractures:a myth or an existing entity?[J] Lupus, 2010, 19:3-12. doi:  10.1177/0961203309353171
    [43] Ansell J, Hirsh J, Dalen J, et al. Managing oral anticoagulant therapy[J]. Chest, 2001, 119:22S-38S.
    [44] Stein MI, Park J, Raterman S. Prevention of VTE Following total hip and knee arthroplasty in Hemophilia patients[J]. Orthopedics, 2011, 34:393. http://europepmc.org/abstract/MED/21553745
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  • 收稿日期:  2017-11-03
  • 刊出日期:  2019-11-30

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