Failure of the American College of Chest Physicians-1A protocol for Lovenox in clinical outcomes for thromboembolic prophylaxis
Failure of the American College of Chest Physicians-1A protocol for Lovenox in clinical outcomes for thromboembolic prophylaxis
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DOI：
10.1016/j.arth.2007.01.007
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发表时间：
2007-04-01
影响因子：
3.5
通讯作者：
Barrack, Robert L.
中科院分区：
文献类型：
--
作者：
Burnett, R. Stephen J.;Clohisy, John C.;Barrack, Robert L.
共有290名连续接受全髋关节和全膝关节置换术的患者前瞻性地进入临床抗凝试验，使用10天的Lovenox疗程，并遵循美国胸科医师学会- 1a指南。9%的患者出现严重并发症；9例（3.8%）患者出现症状性深静脉血栓，3例（1.3%）患者出现非致死性肺栓塞。并发症包括再入院4.7%，3.4%返回手术室切口引流，5.1%延长住院（伤口引流），3.4%注射部位并发症。伤口引流超过7天预示着再入院和伤口再手术。体重指数大于35预示着伤口引流时间延长。与我们之前的研究中使用华法林相比，使用Lovenox返回手术室的伤口并发症发生率增加了3倍。需要再入院或再手术的手术部位并发症应被视为“主要”并发症。
A total of 290 consecutive patients who underwent total hip and total knee arthroplasty were prospectively entered into a clinical anticoagulation trial using a 10-day course of Lovenox with the American College of Chest Physicians-1A guidelines. Major complications occurred in 9% of patients; symptomatic deep vein thrombosis occurred in 9 (3.8%) patients, and nonfatal pulmonary embolism in 3 (1.3%) patients. Complications included 4.7% readmissions, 3.4% return to the operating room for wound incision and drainage, 5.1% prolonged hospitalization (wound drainage), and 3.4% injection site complications. Wound drainage of more than 7 days was predictive of readmission and wound reoperation. A body mass index of more than 35 was predictive of prolonged wound drainage. Return to the operating room for wound complications occurred 3 x more frequently with the use of Lovenox than in our previous study using warfarin. Surgical site complications requiring readmission or reoperation should be considered "major" complications.