Download PDF
CC BY 4.0 · Rev Bras Ortop (Sao Paulo) 2024; 59(06): e883-e887
DOI: 10.1055/s-0044-1785510
Artigo Original
Joelho

Comparação de ácido acetilsalicílico e anticoagulante oral direto como tromboprofilaxia após artroplastia total do joelho: Um estudo retrospectivo

Article in several languages: português | English
Endrotomo Sumargono
1   Departamento de Cirurgia Ortopédica, St. Carolus Hospital, Jakarta, Indonésia
2   Faculdade de Medicina, Universitas Katolik Indonesia Atma Jaya, Indonésia
,
Maria Anastasia
2   Faculdade de Medicina, Universitas Katolik Indonesia Atma Jaya, Indonésia
,
Leonard Christianto Singjie
2   Faculdade de Medicina, Universitas Katolik Indonesia Atma Jaya, Indonésia
,
Ifran Saleh
1   Departamento de Cirurgia Ortopédica, St. Carolus Hospital, Jakarta, Indonésia
3   Departamento de Cirurgia Ortopédica, Faculdade de Medicina, Universitas Indonesia, Jakarta, Indonésia
,
Ira Juliet Anestessia
4   Faculdade de Medicina, Universitas Trisakti, Jakarta, Indonésia
,
Erica Kholinne 
1   Departamento de Cirurgia Ortopédica, St. Carolus Hospital, Jakarta, Indonésia
4   Faculdade de Medicina, Universitas Trisakti, Jakarta, Indonésia
› Author Affiliations Suporte Financeiro Este estudo não recebeu qualquer financiamento específico de agências de fomento dos setores público, comercial ou sem fins lucrativos.
› Further Information
Also available at
   Permissions and Reprints

Resumo

Objetivo O tromboembolismo venoso (TEV) ainda é um grande desafio após grandes cirurgias ortopédicas, incluindo a artroplastia total do joelho (ATJ). O objetivo deste estudo foi estimar o risco de TEV com profilaxia farmacológica apenas com ácido acetilsalicílico ou anticoagulante oral direto (AOD) após a cirurgia primária de ATJ.

Métodos O estudo incluiu 476 pacientes submetidos a ATJ primária de 2016 a 2020. Todos os pacientes receberam tromboprofilaxia com AOD (grupo AOD) (n = 267) ou ácido acetilsalicílico (AAS) (grupo AAS) (n = 209). Os desfechos clínicos foram avaliados e comparados entre aqueles que receberam AOD e AAS. O desfecho primário foi a incidência de TEV. O desfecho secundário foi a ocorrência de complicações da ferida.

Resultado O AAS e o AOD foram comparáveis na prevenção de TEV em pacientes submetidos a ATJ primária. A incidência de trombose venosa profunda foi semelhante nos grupos AAS (10%) e AOD (10,1%, p = 0,98), sem nenhum caso de embolia pulmonar em ambos os grupos. Não houve diferença significativa entre os grupos AAS (1,4%) e AOD (1,5%) em relação às complicações da ferida (p = 0,95).

Conclusão A tromboprofilaxia pós-operatória apenas com AAS não foi associada a um maior risco de TEV pós-operatório em comparação à AOD após ATJ. Considerando a ampla disponibilidade e custo-benefício, o AAS pode ser uma alternativa promissora ao AOD para a profilaxia de TEV.

Palavras-chave

anticoagulantes - artroplastia do joelho - tromboembolia venosa

Contribuições dos Autores

Todos os autores contribuíram para a concepção e delineamento do estudo. A preparação do material, a coleta e a análise dos dados foram realizadas por Maria Anastasia e Leonard Christianto. Todos os autores leram e aprovaram o manuscrito final.


Trabalho desenvolvido no Departamento de Cirurgia Ortopédica, St. Carolus Hospital, Jakarta, Indonésia.




Publication History

Received: 04 March 2023

Accepted: 21 July 2023

Article published online:
21 December 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Referências

  • 1 Skou ST, Roos EM, Laursen MB. et al. A randomized, controlled trial of total knee replacement. N Engl J Med 2015; 373 (17) 1597-1606
    CrossrefPubMedSearch in Google Scholar
  • 2 Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am 2018; 100 (17) 1455-1460
    CrossrefPubMedSearch in Google Scholar
  • 3 Healy WL, Della Valle CJ, Iorio R. et al. Complications of total knee arthroplasty: standardized list and definitions of the Knee Society. Clin Orthop Relat Res 2013; 471 (01) 215-220
    CrossrefPubMedSearch in Google Scholar
  • 4 Lieberman JR, Pensak MJ. Prevention of venous thromboembolic disease after total hip and knee arthroplasty. J Bone Joint Surg Am 2013; 95 (19) 1801-1811
    CrossrefPubMedSearch in Google Scholar
  • 5 Sasaki H, Ishida K, Shibanuma N. et al. Retrospective comparison of three thromboprophylaxis agents, edoxaban, fondaparinux, and enoxaparin, for preventing venous thromboembolism in total knee arthroplasty. Int Orthop 2014; 38 (03) 525-529
    CrossrefPubMedSearch in Google Scholar
  • 6 Lewis CG, Inneh IA, Schutzer SF, Grady-Benson J. Evaluation of the first-generation AAOS clinical guidelines on the prophylaxis of venous thromboembolic events in patients undergoing total joint arthroplasty: experience with 3289 patients from a single institution. J Bone Joint Surg Am 2014; 96 (16) 1327-1332
    CrossrefPubMedSearch in Google Scholar
  • 7 Matharu GS, Kunutsor SK, Judge A, Blom AW, Whitehouse MR. Clinical Effectiveness and safety of aspirin for venous thromboembolism prophylaxis after total hip and knee replacement: A systematic review and meta-analysis of randomized clinical trials. JAMA Intern Med 2020; 180 (03) 376-384
    CrossrefPubMedSearch in Google Scholar
  • 8 Raphael IJ, Tischler EH, Huang R, Rothman RH, Hozack WJ, Parvizi J. Aspirin: an alternative for pulmonary embolism prophylaxis after arthroplasty?. Clin Orthop Relat Res 2014; 472 (02) 482-488
    CrossrefPubMedSearch in Google Scholar
  • 9 Worldbank. Indonesia | Data, (n.d.). Available from: https://data.worldbank.org/country/ID . [Accessed October 17, 2022]
  • 10 The ICM-VTE Hip & Knee Delegates. Recommendations from the ICM-VTE: Hip & Knee. [published correction appears in J Bone Joint Surg Am. 2022 Aug 3;104(15):e70] J Bone Joint Surg Am 2022; 104 (Suppl. 01) 180-231
    CrossrefPubMedSearch in Google Scholar
  • 11 Etzioni DA, Lessow C, Bordeianou LG. et al. Venous Thromboembolism after Inpatient Surgery in Administrative Data vs NSQIP: A Multi-Institutional Study. J Am Coll Surg 2018; 226 (05) 796-803
    CrossrefPubMedSearch in Google Scholar
  • 12 Baumgartner C, Maselli J, Auerbach AD, Fang MC. Aspirin compared with anticoagulation to prevent venous thromboembolism after knee or hip arthroplasty: a large retrospective cohort study. J Gen Intern Med 2019; 34 (10) 2038-2046
    CrossrefPubMedSearch in Google Scholar
  • 13 Sun G, Wu J, Wang Q. et al. Factor Xa inhibitors and direct thrombin inhibitors versus low-molecular-weight heparin for thromboprophylaxis after total hip or total knee arthroplasty: A systematic review and meta-analysis. J Arthroplasty 2019; 34 (04) 789-800.e6
    CrossrefPubMedSearch in Google Scholar
  • 14 Deirmengian GK, Heller S, Smith EB, Maltenfort M, Chen AF, Parvizi J. Aspirin can be used as prophylaxis for prevention of venous thromboembolism after revision hip and knee arthroplasty. J Arthroplasty 2016; 31 (10) 2237-2240
    CrossrefPubMedSearch in Google Scholar
  • 15 Anderson DR, Dunbar M, Murnaghan J. et al. Aspirin or rivaroxaban for VTE prophylaxis after hip or knee arthroplasty. N Engl J Med 2018; 378 (08) 699-707
    CrossrefPubMedSearch in Google Scholar
  • 16 Farey JE, An VVG, Sidhu V, Karunaratne S, Harris IA. Aspirin versus enoxaparin for the initial prevention of venous thromboembolism following elective arthroplasty of the hip or knee: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2021; 107 (01) 102606
    CrossrefPubMedSearch in Google Scholar
  • 17 Venker BT, Ganti BR, Lin H, Lee ED, Nunley RM, Gage BF. Safety and efficacy of new anticoagulants for the prevention of venous thromboembolism after hip and knee arthroplasty: A meta-analysis. J Arthroplasty 2017; 32 (02) 645-652
    CrossrefPubMedSearch in Google Scholar
  • 18 Le G, Yang C, Zhang M. et al. Efficacy and safety of aspirin and rivaroxaban for venous thromboembolism prophylaxis after total hip or knee arthroplasty: A protocol for meta-analysis. Medicine (Baltimore) 2020; 99 (49) e23055
    CrossrefPubMedSearch in Google Scholar
  • 19 Xu J, Kanagaratnam A, Cao JY, Chaggar GS, Bruce W. A comparison of aspirin against rivaroxaban for venous thromboembolism prophylaxis after hip or knee arthroplasty: A meta-analysis. J Orthop Surg (Hong Kong) 2020; 28 (01) 2309499019896024
    CrossrefPubMedSearch in Google Scholar
  • 20 Jenny JY, Bulaid Y, Boisrenoult P. et al; French Society of Orthopaedic Surgery, Traumatology (SofCOT). Bleeding and thromboembolism risk of standard antithrombotic prophylaxis after hip or knee replacement within an enhanced recovery program. Orthop Traumatol Surg Res 2020; 106 (08) 1533-1538
    CrossrefPubMedSearch in Google Scholar
  • 21 Wilson DG, Poole WE, Chauhan SK, Rogers BA. Systematic review of aspirin for thromboprophylaxis in modern elective total hip and knee arthroplasty. Bone Joint J 2016; 98-B (08) 1056-1061
    CrossrefPubMedSearch in Google Scholar
  • 22 Lassen MR, Gent M, Kakkar AK. et al. The effects of rivaroxaban on the complications of surgery after total hip or knee replacement: results from the RECORD programme. J Bone Joint Surg Br 2012; 94 (11) 1573-1578
    CrossrefPubMedSearch in Google Scholar
  • 23 Kulshrestha V, Kumar S. DVT prophylaxis after TKA: routine anticoagulation vs risk screening approach - a randomized study. J Arthroplasty 2013; 28 (10) 1868-1873
    CrossrefPubMedSearch in Google Scholar
  • 24 Singh V, Shahi A, Saleh U, Tarabichi S, Oliashirazi A. Persistent wound drainage among total joint arthroplasty patients receiving aspirin vs coumadin. J Arthroplasty 2020; 35 (12) 3743-3746
    CrossrefPubMedSearch in Google Scholar
  • 25 Garfinkel JH, Gladnick BP, Roland N, Romness DW. Increased incidence of bleeding and wound complications with Factor-Xa inhibitors after total joint arthroplasty. J Arthroplasty 2018; 33 (02) 533-536
    CrossrefPubMedSearch in Google Scholar
  • 26 Parvizi J, Huang R, Restrepo C. et al. Low-dose aspirin is effective chemoprophylaxis against clinically important venous thromboembolism following total joint arthroplasty: A preliminary analysis. J Bone Joint Surg Am 2017; 99 (02) 91-98
    CrossrefPubMedSearch in Google Scholar
  • 27 Peraturan Menteri Kesehatan Republik Indonesia. (n.d.). Available from: www.inaproc.lkpp.go.id ; [accessed October 17, 2022].