协和医学杂志

2019, v.10(06) 639-646

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阿司匹林:关节置换术后抗凝新观念
Aspirin:A New Choice for Prevention of Venous Thromboembolism after Arthroplasty

曹时亮;任毅;冯宾;
CAO Shi-liang;REN Yi;FENG Bin;Department of Orthopedic Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

摘要(Abstract):

静脉血栓栓塞症是关节置换术后严重并发症,有效的术后抗凝是其最主要的预防及治疗措施。低分子肝素、Xa因子抑制剂等抗凝药物是目前预防静脉血栓栓塞症的首选药物,虽然其疗效肯定,出血风险较低,但仍存在价格较高、使用及保存不便等问题。近年来,部分指南及研究认为抗血小板药物阿司匹林同样可用于关节置换术后静脉血栓栓塞症的预防,其与抗凝药物预防效果相似,安全性好,具有价格低廉、无须监测、口服方便等优点,且小剂量阿司匹林即可有足够的预防效果。另有研究认为,阿司匹林相比于抗凝药物,围手术期出血风险更低。总之,阿司匹林用于关节置换术后静脉血栓栓塞症预防疗效肯定且安全性好,是关节置换术后抗凝药物的新选择。
Venous thromboembolism is a serious complication after orthopedics arthroplasty,which could result in significant loss of patients' satisfaction with the artificial joint. In some extreme cases,it also could lead to the death from respiratory and circulatory failure. The most important and effective method to prevent this complication is preoperative anti-coagulation therapy that could greatly reduce the incidence of venous thromboembolism after arthroplasty. Anticoagulant drugs,such as low molecular weight heparin,Xa factor inhibitors,are the first choices for anti-coagulation therapy after arthroplasty. These drugs have certain effectiveness and low risk of postoperative bleeding,but there are still some deficiencies,including expensiveness,parenteral administration,and so on. Aspirin is a historical antiplatelet drug. Now some guides and researches suggest it also can be a choice for the prevention of venous thromboembolism after arthroplasty. In these researches,aspirin was found to have similar prophylactic effect and safety compared to anticoagulant drugs in the prevention of venous thromboembolism after arthroplasty. Aspirin is cheaper and economical. It can be administered orally,which is convenient for patients. Some researchers also believe aspirin has a lower bleeding rate compared with anticoagulant drugs. In terms of drug dose,low-dose aspirin has a sufficient preventive effect for venous thromboembolism,which could reduce the side effect of gastrointestinal adverse reactions. In conclusion,aspirin is a new choice for the prevention of venous thromboembolism after arthroplasty.

关键词(KeyWords): 阿司匹林;静脉血栓栓塞症;预防;关节置换术
aspirin;venous thromboembolism;prevention;arthroplasty

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基金项目(Foundation): 国家自然科学基金(81871740)

作者(Author): 曹时亮;任毅;冯宾;
CAO Shi-liang;REN Yi;FENG Bin;Department of Orthopedic Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

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