Low-dose warfarin for prevention of symptomatic thromboembolism after orthopedic surgery
Low-dose warfarin for prevention of symptomatic thromboembolism after orthopedic surgery
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DOI：
10.1345/aph.1e536
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发表时间：
2005-06-01
影响因子：
2.9
通讯作者：
Jones, RJ
中科院分区：
文献类型：
--
作者：
Enyart, JJ;Jones, RJ
背景技术背景：据报道，在全膝关节置换术（TKR）和全髋关节置换术（THR）后，使用目标国际标准化比值（INR）范围为1.5-2.5的华法林剂量不足以预防静脉血栓栓塞（VTE）。评价TKR和THR手术后症状性VTE的发生率，（INR 1.5-2.5）华法林方案开始手术前一天晚上与文献队列治疗依诺肝素进行比较。方法：TKR/THR患者接受21天低剂量华法林方案治疗，通过连续观察设计进行随访。主要结局指标为症状性VTE和肺栓塞（PE），次要结局为大出血和死亡。将低剂量华法林与接受依诺肝素治疗的患者的文献队列进行比较，这些患者接受依诺肝素治疗的时间相似，并评价相同的结局。队列事件发生率采用DerSimonian模型计算加权平均值。结果：低剂量华法林组VTE、PE、出血和死亡分别为8例（1.04%）、4例（0.52%）、8例（1.04%）和4例（0.52%）。队列加权平均值分别为35（1.33%）、19（0.72%）、65（2.46%）和18（0.67%）。低剂量华法林治疗VTE、PE和VTE + PE的比值比分别为0.778（95% CI 0.36 - 1.68）、0.717（0.24 - 2.11）和0.754（0.41 - 1.42），均无显著性。出血和死亡的比值比分别为0.420（0.20至0.87; p = 0.02）和0.756（0.26至2.24; NS），分别。结论：对于本评价，低剂量华法林与依诺肝素队列的VTE，PE，和VTE+PE的发展。依诺肝素组的出血发生率显著高于接受低剂量华法林治疗的患者。
BACKGROUND: Warfarin dosing with a target international normalized ratio (INR) range of 1.5-2.5 has not been reported as adequate for venous thromboembolism (VTE) prophylaxis after total knee (TKR) and total hip replacement (THR) surgery.OBJECTIVE: To evaluate the rate of symptomatic VTE after TKR and THR surgery using a low-dose (INR 1.5-2.5) warfarin protocol started the evening before surgery compared with a literature cohort treated with enoxaparin.METHODS: TKR/THR patients treated with a 21-day low-dose warfarin protocol were followed via a consecutive observational design. Main outcome measures were symptomatic VTE and pulmonary embolism (PE), with major bleeds and death as secondary outcomes. Low-dose warfarin was compared with a literature cohort of patients treated with enoxaparin who received enoxaparin for a similar length of time and was evaluated for the same outcomes. Cohort event rates were derived as a weighted average using the DerSimonian model.RESULTS: VTE, PE, bleeds, and deaths in the low-dose warfarin group were 8 (1.04%), 4 (0.52%), 8 (1.04%), and 4 (0.52%), respectively. The cohort weighted average values were 35 (1.33%), 19 (0.72%), 65 (2.46%), and 18 (0.67%), respectively. Odds ratios for low-dose warfarin for VTE, PE, and VTE plus PE were 0.778 (95% Cl 0.36 to 1.68), 0.717 (0.24 to 2.11), and 0.754 (0.41 to 1.42), respectively, all nonsignificant. Odds ratios for bleeds and death were 0.420 (0.20 to 0.87; p = 0.02) and 0.756 (0.26 to 2.24; NS), respectively.CONCLUSIONS: For this evaluation, low-dose warfarin was comparable to the enoxaparin cohort for development of VTE, PE, and VTE+PE. Incidences of bleeds in the enoxaparin cohort were significantly higher than in patients receiving low-dose warfarin.