Drescher Frank S, Sirovich Brenda E, Lee Alexandra, Morrison Daniel H, Chiang Wesley H, Larson Robin J
Geisel School of Medicine at Dartmouth, Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, White River Junction, Vermont.
J Hosp Med. 2014 Sep;9(9):579-85. doi: 10.1002/jhm.2224. Epub 2014 Jul 17.
Hip fracture surgery and lower extremity arthroplasty are associated with increased risk of both venous thromboembolism and bleeding. The best pharmacologic strategy for reducing these opposing risks is uncertain.
To compare venous thromboembolism (VTE) and bleeding rates in adult patients receiving aspirin versus anticoagulants after major lower extremity orthopedic surgery.
Medline, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library through June 2013; reference lists, ClinicalTrials.gov, and scientific meeting abstracts.
Randomized trials comparing aspirin to anticoagulants for prevention of VTE following major lower extremity orthopedic surgery.
Two reviewers independently extracted data on rates of VTE, bleeding, and mortality.
Of 298 studies screened, 8 trials including 1408 participants met inclusion criteria; all trials screened participants for deep venous thrombosis (DVT). Overall rates of DVT did not differ statistically between aspirin and anticoagulants (relative risk [RR]: 1.15 [95% confidence interval {CI}: 0.68-1.96]). Subgrouped by type of surgery, there was a nonsignificant trend favoring anticoagulation following hip fracture repair but not knee or hip arthroplasty (hip fracture RR: 1.60 [95% CI: 0.80-3.20], 2 trials; arthroplasty RR: 1.00 [95% CI: 0.49-2.05], 5 trials). The risk of bleeding was lower with aspirin than anticoagulants following hip fracture repair (RR: 0.32 [95% CI: 0.13-0.77], 2 trials), with a nonsignificant trend favoring aspirin after arthroplasty (RR: 0.63 [95% CI: 0.33-1.21], 5 trials). Rates of pulmonary embolism were too low to provide reliable estimates.
Compared with anticoagulation, aspirin may be associated with higher risk of DVT following hip fracture repair, although bleeding rates were substantially lower. Aspirin was similarly effective after lower extremity arthroplasty and may be associated with lower bleeding risk. Journal of Hospital Medicine 2014;9:579-585. © 2014 Society of Hospital Medicine.
髋部骨折手术和下肢关节置换术会增加静脉血栓栓塞和出血的风险。降低这些相反风险的最佳药物策略尚不确定。
比较接受阿司匹林与抗凝剂治疗的成年患者在下肢大手术后发生静脉血栓栓塞（VTE）和出血的发生率。
截至2013年6月的Medline、护理及相关健康文献累积索引和Cochrane图书馆；参考文献列表、ClinicalTrials.gov及科学会议摘要。
比较阿司匹林与抗凝剂预防下肢大手术后VTE的随机试验。
两名研究者独立提取VTE、出血和死亡率的数据。
在筛选的298项研究中，8项试验（包括1408名参与者）符合纳入标准；所有试验均对参与者进行了深静脉血栓形成（DVT）筛查。阿司匹林组和抗凝剂组的总体DVT发生率在统计学上无差异（相对风险[RR]：1.15[95%置信区间{CI}：0.68 - 1.96]）。按手术类型分组，髋部骨折修复术后抗凝治疗有不显著的优势趋势，但在膝关节或髋关节置换术后则无此趋势（髋部骨折RR：1.60[95%CI：0.80 - 3.20]，2项试验；关节置换术RR：1.00[95%CI：0.49 - 2.05]，5项试验）。髋部骨折修复术后阿司匹林组的出血风险低于抗凝剂组（RR：0.32[95%CI：0.13 - 0.77]，2项试验），关节置换术后有不显著的趋势表明阿司匹林更具优势（RR：0.63[95%CI：0.33 - 1.21]，5项试验）。肺栓塞发生率过低，无法提供可靠估计值。
与抗凝治疗相比，髋部骨折修复术后阿司匹林可能与更高的DVT风险相关，尽管出血率显著更低。下肢关节置换术后阿司匹林同样有效，且可能与更低的出血风险相关。《医院医学杂志》2014年；9：579 - 585。©2014医院医学协会。
