Sagar Telang BS, Ryan Palmer BS, Andrew Dobitsch MD, Jacob R. Ball MD, Nathanael D. Heckmann MD, Jay R. Lieberman MD
{"title":"接受阿哌沙班预防血栓形成治疗的全关节置换术患者围手术期应考虑使用氨甲环酸","authors":"Sagar Telang BS, Ryan Palmer BS, Andrew Dobitsch MD, Jacob R. Ball MD, Nathanael D. Heckmann MD, Jay R. Lieberman MD","doi":"10.1016/j.artd.2024.101548","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>This study aims to investigate if the perioperative administration of tranexamic acid (TXA) for total joint arthroplasty (TJA) patients receiving apixaban for thromboprophylaxis can reduce the risk of postoperative bleeding without increasing the rate of thromboembolic events.</div></div><div><h3>Methods</h3><div>The Premier Healthcare Database was utilized to identify all primary elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients. Patients receiving apixaban during their in-hospital admission who received TXA on the day of surgery were compared to those who did not receive TXA. Differences in demographics, hospital characteristics, and comorbidities were assessed between groups. Univariate and multivariable regressions were utilized to assess differences in 90-day bleeding, thromboembolic, and medical postoperative outcomes between cohorts.</div></div><div><h3>Results</h3><div>In total, 118,219 TJA patients were identified (TKA: 65.3%; THA: 34.7%), of which 30,592 (25.9%) received apixaban alone, and 87,627 (74.1%) received apixaban and TXA. Multivariable analyses found that patients who received apixaban and TXA had a reduced risk of aggregate bleeding complications (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI]: 0.81-0.86, <em>P</em> < .001), transfusion (aOR 0.47, 95% CI: 0.43-0.52, <em>P</em> < .001), acute anemia (aOR 0.84, 95% CI: 0.81-0.87, <em>P</em> < .001), deep vein thrombosis (aOR 0.74, 95% CI: 0.66-0.83, <em>P</em> < .001), and pulmonary embolism (aOR 0.84, 95% CI: 0.72-0.96, <em>P</em> = .012). No differences between cohorts were observed for risk of stroke (aOR 1.09, 95% CI: 0.82-1.46, <em>P</em> = .372) and myocardial infarction (aOR 0.94, 95% CI: 0.76-1.16, <em>P</em> = .564).</div></div><div><h3>Conclusions</h3><div>Perioperative administration of TXA to TJA patients receiving apixaban reduces the risk of bleeding complications without increasing thromboembolic risk. Arthroplasty surgeons should strongly consider providing TXA to TJA patients receiving apixaban.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Perioperative Tranexamic Acid Should Be Considered for Total Joint Arthroplasty Patients Receiving Apixaban for Thromboprophylaxis\",\"authors\":\"Sagar Telang BS, Ryan Palmer BS, Andrew Dobitsch MD, Jacob R. Ball MD, Nathanael D. Heckmann MD, Jay R. Lieberman MD\",\"doi\":\"10.1016/j.artd.2024.101548\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>This study aims to investigate if the perioperative administration of tranexamic acid (TXA) for total joint arthroplasty (TJA) patients receiving apixaban for thromboprophylaxis can reduce the risk of postoperative bleeding without increasing the rate of thromboembolic events.</div></div><div><h3>Methods</h3><div>The Premier Healthcare Database was utilized to identify all primary elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients. Patients receiving apixaban during their in-hospital admission who received TXA on the day of surgery were compared to those who did not receive TXA. Differences in demographics, hospital characteristics, and comorbidities were assessed between groups. Univariate and multivariable regressions were utilized to assess differences in 90-day bleeding, thromboembolic, and medical postoperative outcomes between cohorts.</div></div><div><h3>Results</h3><div>In total, 118,219 TJA patients were identified (TKA: 65.3%; THA: 34.7%), of which 30,592 (25.9%) received apixaban alone, and 87,627 (74.1%) received apixaban and TXA. Multivariable analyses found that patients who received apixaban and TXA had a reduced risk of aggregate bleeding complications (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI]: 0.81-0.86, <em>P</em> < .001), transfusion (aOR 0.47, 95% CI: 0.43-0.52, <em>P</em> < .001), acute anemia (aOR 0.84, 95% CI: 0.81-0.87, <em>P</em> < .001), deep vein thrombosis (aOR 0.74, 95% CI: 0.66-0.83, <em>P</em> < .001), and pulmonary embolism (aOR 0.84, 95% CI: 0.72-0.96, <em>P</em> = .012). No differences between cohorts were observed for risk of stroke (aOR 1.09, 95% CI: 0.82-1.46, <em>P</em> = .372) and myocardial infarction (aOR 0.94, 95% CI: 0.76-1.16, <em>P</em> = .564).</div></div><div><h3>Conclusions</h3><div>Perioperative administration of TXA to TJA patients receiving apixaban reduces the risk of bleeding complications without increasing thromboembolic risk. Arthroplasty surgeons should strongly consider providing TXA to TJA patients receiving apixaban.</div></div>\",\"PeriodicalId\":37940,\"journal\":{\"name\":\"Arthroplasty Today\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2024-11-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arthroplasty Today\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2352344124002334\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroplasty Today","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2352344124002334","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Perioperative Tranexamic Acid Should Be Considered for Total Joint Arthroplasty Patients Receiving Apixaban for Thromboprophylaxis
Background
This study aims to investigate if the perioperative administration of tranexamic acid (TXA) for total joint arthroplasty (TJA) patients receiving apixaban for thromboprophylaxis can reduce the risk of postoperative bleeding without increasing the rate of thromboembolic events.
Methods
The Premier Healthcare Database was utilized to identify all primary elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients. Patients receiving apixaban during their in-hospital admission who received TXA on the day of surgery were compared to those who did not receive TXA. Differences in demographics, hospital characteristics, and comorbidities were assessed between groups. Univariate and multivariable regressions were utilized to assess differences in 90-day bleeding, thromboembolic, and medical postoperative outcomes between cohorts.
Results
In total, 118,219 TJA patients were identified (TKA: 65.3%; THA: 34.7%), of which 30,592 (25.9%) received apixaban alone, and 87,627 (74.1%) received apixaban and TXA. Multivariable analyses found that patients who received apixaban and TXA had a reduced risk of aggregate bleeding complications (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI]: 0.81-0.86, P < .001), transfusion (aOR 0.47, 95% CI: 0.43-0.52, P < .001), acute anemia (aOR 0.84, 95% CI: 0.81-0.87, P < .001), deep vein thrombosis (aOR 0.74, 95% CI: 0.66-0.83, P < .001), and pulmonary embolism (aOR 0.84, 95% CI: 0.72-0.96, P = .012). No differences between cohorts were observed for risk of stroke (aOR 1.09, 95% CI: 0.82-1.46, P = .372) and myocardial infarction (aOR 0.94, 95% CI: 0.76-1.16, P = .564).
Conclusions
Perioperative administration of TXA to TJA patients receiving apixaban reduces the risk of bleeding complications without increasing thromboembolic risk. Arthroplasty surgeons should strongly consider providing TXA to TJA patients receiving apixaban.
期刊介绍：
Arthroplasty Today is a companion journal to the Journal of Arthroplasty. The journal Arthroplasty Today brings together the clinical and scientific foundations for joint replacement of the hip and knee in an open-access, online format. Arthroplasty Today solicits manuscripts of the highest quality from all areas of scientific endeavor that relate to joint replacement or the treatment of its complications, including those dealing with patient outcomes, economic and policy issues, prosthetic design, biomechanics, biomaterials, and biologic response to arthroplasty. The journal focuses on case reports. It is the purpose of Arthroplasty Today to present material to practicing orthopaedic surgeons that will keep them abreast of developments in the field, prove useful in the care of patients, and aid in understanding the scientific foundation of this subspecialty area of joint replacement. The international members of the Editorial Board provide a worldwide perspective for the journal''s area of interest. Their participation ensures that each issue of Arthroplasty Today provides the reader with timely, peer-reviewed articles of the highest quality.
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