El ácido acetilsalicílico no es para todos: el alta a centros no domiciliarios tras artroplastia total de cadera y rodilla aumenta el riesgo de tromboembolia venosa

BACKGROUND: Patients discharged to non-home facilities (NHD) after total hip arthroplasty (THA) and total knee (TKA) arthroplasty experience higher rates of adverse events and may require more aggressive venous thromboembolism (VTE) chemoprophylaxis. Our aim was to compare the rates of VTE in NHD patients and those discharged home (HD) after THA/TKA. Our secondary aim was to determine VTE rates within HD and NHD groups when stratified by chemoprophylactic regimen. METHODS: A retrospective cohort of primary THA and TKA patients were stratified into HD and NHD, then allocated into groups by chemoprophylactic regimen on discharge: aspirin alone (AA), more aggressive (MA) chemoprophylaxis, and other regimens (other). The primary outcome was VTE. Rates of VTE in HD and NHD patients, as well as AA and MA regimens, were analyzed using a generalized linear regression model. RESULTS: Six thousand three hundred seventy-nine patients were included with 1.03% experiencing VTE. HD had lower rates of VTE compared to NHD (0.83% vs 2.17%, P < .001). AA had similar rates of VTE compared to MA (0.99% vs 1.08%, P = .82). NHD patients had a lower VTE rate with MA vs AA prophylaxis (1.47% vs 3.83%, P = .016). HD patients treated with AA vs MA had no difference in VTE rates (0.76% vs 0.96%, P = .761). CONCLUSIONS: NHD patients have higher rates of VTE than HD patients. However, NHD patients have significantly lower rates of VTE on MA chemoprophylaxis compared to those on AA. Providers should consider prescribing MA VTE chemoprophylaxis for NHD patients. Prospective, randomized studies are necessary to confirm these recommendations.

Resumen tomado de PubMed (NCBI) para el registro citado, en el idioma original. La versión de referencia es la de la publicación original.

El resumen se deja sin traducir para conservar la redacción original de los autores.

De 6379 pacientes con artroplastia de cadera o rodilla, el 1,03 % sufrió tromboembolia venosa. El alta domiciliaria tuvo menos eventos que la derivación a centros (0,83 % frente a 2,17 %; p < 0,001). Ácido acetilsalicílico solo y pauta agresiva no difirieron (0,99 % frente a 1,08 %; p = 0,82), pero en centros la pauta agresiva se asoció con menos eventos (1,47 % frente a 3,83 %; p = 0,016). Los autores la sugieren; faltan ensayos aleatorizados.

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