El tratamiento trombofiláctico no afecta los niveles de hemoglobina y hematocrito luego de una artroplastia total de cadera

• Santiago L. Iglesias ^[1] ; Adrián G. Almada ^[1] ; Pablo D. López ^[1] ; Ignacio J. Pioli ^[1] ; Martín M. Mangupli ^[1] ; José M. Gómez ^[1] ; Bartolomé L. Allende ^[1]
  1. [1] Sanatorio Allende, Córdoba, Argentina
• Localización: Revista de la Asociación Argentina de Ortopedia y Traumatología, ISSN 1852-7434, Vol. 89, Nº. 5, 2024, págs. 450-461
• Idioma: español
• DOI: 10.15417/issn.1852-7434.2024.89.5.1958
• Títulos paralelos:
  • Thromboprophylaxis Treatment Does Not Affect Hemoglobin and Hematocrit Levels After Elective Total Hip Arthroplasty
• Enlaces
  • Texto completo  1    2  
• Resumen
  • español

    Introducción: La anemia posoperatoria es una complicación importante en pacientes sometidos a una artroplastia total de cadera (ATC). El objetivo principal de este estudio fue evaluar la prevalencia de anemia posoperatoria en pacientes sometidos a una ATC programada y determinar si está relacionada con el tratamiento tromboprofiláctico administrado.

    Materiales y Métodos: Ensayo prospectivo aleatorizado. Se incluyó a 358 pacientes sometidos a una ATC programada entre febrero de 2019 y enero de 2022, que fueron divididos en 3 grupos para recibir: rivaroxabán 10 mg, enoxaparina sódica 40 mg o aspirina 100 mg como estrategia de tromboprofilaxis diaria.

    Resultados: No hubo casos de enfermedad tromboembólica confirmada ni de hemorragia grave. Los niveles de hemoglobina y hematocrito fueron similares en todos los grupos de tratamiento, sin diferencias estadísticamente significativas. No se hallaron diferencias en la incidencia de complicaciones. La suplementación con hierro fue significativamente mayor en el grupo de enoxaparina (p = 0,041). La incidencia de anemia en el modelo de regresión ordinal se asoció con la edad (OR 1,02; IC95% 1,00-1,05; p 0,04), el sexo masculino (OR 0,33; IC95% 0,19-0,56; p <0,01) y la presencia de una comorbilidad (OR 0,49; IC95% 0,28-0,85; p 0,012).

    Conclusiones: La tromboprofilaxis utilizada no tiene impacto en el desarrollo de la anemia posoperatoria en pacientes sometidos a una ATC. El sexo masculino, la edad y la presencia de alguna comorbilidad parecen ser los factores que influyen negativamente en la anemia. No hubo diferencias significativas en el perfil de seguridad de estas tres terapias de tromboprofilaxis.

  • English

    Background: Postoperative anemia is a significant complication in patients undergoing total hip arthroplasty (THA). The primary objective of this study was to evaluate the prevalence of postoperative anemia in patients undergoing elective THA and to deter-mine whether there is a relationship with the thromboprophylactic treatment used. Materials and Methods: This was a prospective randomized trial. A total of 358 patients who underwent elective THA between February 2019 and January 2022 were included. Patients were divided into three groups receiving daily thromboprophylaxis: rivaroxaban 10 mg, enoxaparin sodium 40 mg, or aspirin 100 mg. Results: No confirmed cases of thromboembolic disease or severe bleeding were reported. Hemoglobin and he-matocrit levels were consistent across all treatment groups, with no statistically significant differences. There were no differences in complication rates among the groups. However, iron supplementation was significantly higher in the enoxaparin group (p = 0.041). In the ordinal regression model, the incidence of anemia was associated with age (OR 1.02, 95% CI 1.00-1.05, p = 0.04), male sex (OR 0.33, 95% CI 0.19-0.56, p < 0.01), and the presence of any comorbidity (OR 0.49, 95% CI 0.28-0.85, p = 0.012). Conclu-sions: The thromboprophylaxis treatments evaluated in this study had no impact on the development of postoperative anemia in patients undergoing THA. Male sex, age, and the presence of comorbidities appear to be the factors most negatively influencing the development of anemia. No significant differences were found in the safety profiles of the three thromboprophylaxis therapies.

• Referencias bibliográficas
  • Grosso MJ, Boddapati V, Cooper H, Geller JA, Shah RP, Neuwirth A. The effect of postoperative anemia on complications after total hip arthroplasty....
  • Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB. An analysis of blood management in patients having a total hip or knee...
  • Spahn DR. Anemia and patient blood management in hip and knee surgery: a systematic review of the literatura. Anesthesiology 2010;113(2):482-95....
  • Myers E, Grady PO, Dolan AM. The influence of preclinical anaemia on outcome following total hip replacement. Arch Orthop Trauma Surg 2004;124(10):699-701....
  • Steuber TD, Howard ML, Nisly SA. Strategies for the management of postoperative anemia in elective orthopedic surgery. Ann Pharmacother 2016;50(7):578-85....
  • Izushi Y, Shiota N, Tetsunaga T, Shimada K, Egawa T, Kiuchi T, et al. The clinical impact of edoxaban for the patients with postoperative...
  • Bala A, Murasko MJ, Burk DR, Huddleston 3rd JI, Goodman SB, Maloney WJ, et al. Venous thromboprophylaxis after total hip arthroplasty: aspirin,...
  • Chen AF, Klatt BA, Yazer MH, Waters JH. Blood utilization after primary total joint arthroplasty in a large hospital network. HSS J 2013;9(2):123-8....
  • Tan TL, Foltz C, Huang R, Chen AF, Higuera C, Siqueira M, et al. Potent anticoagulation does not reduce venous thromboembolism in high-risk...
  • Eriksson BI, Borris LC, Friedman RJ, Haas S, Huisman MV, Kakkar AK, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip...
  • Matharu GS, Kunutsor SK, Judge A, Blom AW, Whitehouse MR. Clinical effectiveness and safety of aspirin for venous thromboembolism prophylaxis...
  • Muscatelli SR, Zheng H, Hughes RE, Cowen ME, Hallstrom BR. Non-inferiority of aspirin for venous thromboembolism prophylaxis After hip arthroplasty...
  • Matharu GS, Garriga C, Whitehouse MR, Rangan A, Judge A. Is aspirin as effective as the newer direct oral anticoagulants for venous thromboembolism...