Is Aspirin Safe for Thromboprophylaxis After Surgery for Lower Extremity Neoplastic Pathologic Fractures?

IF 2 3区 医学 Q3 ONCOLOGY Journal of Surgical Oncology Pub Date : 2024-11-26 DOI:10.1002/jso.27997
Matthew S Chen, Brandon S Gettleman, Kevin C Liu, Mary K Richardson, Arad Talehakimi, Nathanael D Heckmann, Lawrence Menendez, Alexander B Christ
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Abstract

Background and objectives: Both malignancy and orthopedic surgery are known risk factors for developing venous thromboembolism (VTE). Therefore, this study aimed to compare VTE rates among patients receiving enoxaparin, apixaban, rivaroxaban, or aspirin (ASA).

Methods: The Premier Healthcare Database was utilized to identify all patients who underwent surgery for neoplastic pathologic fractures of the lower extremities from 2015 to 2021. Four cohorts based on receipt of ASA, apixaban, enoxaparin, or rivaroxaban were identified. Propensity matching with the enoxaparin cohort as the comparator was performed. Patient demographics, hospital factors, comorbidities, and 90-day complications were compared.

Results: From 2015 to 2021, 3762 patients underwent surgical intervention for neoplastic pathologic fracture of the lower extremities. Enoxaparin recipients showed significantly lower aggregate VTE rates than those on apixaban (p = 0.008) while exhibiting higher VTE occurrence than ASA-treated patients (p = 0.050).

Conclusion: Our study demonstrates that the administration of enoxaparin in patients undergoing surgical intervention for neoplastic pathologic fractures of the lower extremities may lead to significantly higher rates of aggregate VTE postoperatively compared to ASA. This data suggests that further research is warranted to determine if surgeons may safely consider using ASA in patients with no other reported risk factors or need for anticoagulation postoperatively, even in active malignancy.

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下肢肿瘤性病理性骨折术后使用阿司匹林预防血栓形成是否安全?
背景和目的:恶性肿瘤和骨科手术都是导致静脉血栓栓塞(VTE)的已知风险因素。因此,本研究旨在比较接受依诺肝素、阿哌沙班、利伐沙班或阿司匹林(ASA)治疗的患者的 VTE 发生率:方法:利用 Premier Healthcare 数据库来识别 2015 年至 2021 年期间因下肢肿瘤性病理性骨折而接受手术的所有患者。根据接受 ASA、阿哌沙班、依诺肝素或利伐沙班治疗的情况确定了四个队列。以依诺肝素队列为参照物进行倾向匹配。比较了患者人口统计学、医院因素、合并症和 90 天并发症:2015年至2021年,3762名患者因下肢肿瘤性病理性骨折接受了手术治疗。接受依诺肝素治疗的患者VTE总发生率明显低于接受阿哌沙班治疗的患者(P = 0.008),同时VTE发生率高于接受ASA治疗的患者(P = 0.050):我们的研究表明,与 ASA 相比,因下肢肿瘤性病理性骨折接受手术治疗的患者使用依诺肝素可能会导致术后 VTE 总发生率显著升高。这些数据表明,有必要进一步研究,以确定外科医生是否可以安全地考虑在没有其他风险因素或术后需要抗凝的患者中使用 ASA,即使是活动性恶性肿瘤患者。
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来源期刊
CiteScore
4.70
自引率
4.00%
发文量
367
审稿时长
2 months
期刊介绍: The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.
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