Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China.
Am J Sports Med. 2019 Jul;47(8):1994-2002. doi: 10.1177/0363546518782705. Epub 2018 Aug 16.
Low-molecular-weight heparin (LMWH) thromboprophylaxis is widely used for reducing the risk of thrombosis after major orthopaedic surgery. However, the effect and safety on knee arthroscopic surgery are still controversial.
To assess the efficacy and safety of LMWH for the prevention of symptomatic venous thromboembolism (VTE) after knee arthroscopic surgery and anterior cruciate ligament reconstruction (ACLR) by conducting a meta-analysis of randomized controlled trials (RCTs).
Meta-analysis.
The authors searched the electronic databases of MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov , and Web of Science for all studies from inception to June 30, 2017. All selected studies were categorized into 2 subgroups: simple knee arthroscopic surgery and ACLR. The primary effect and safety endpoint were the incidence of major VTE and major bleeding events (BEs), respectively. The secondary effect and safety endpoint were the incidence of all VTE and all BEs, respectively. Relative risks (RRs) with 95% CIs were calculated using Review Manager 5.3.
Eight RCTs with 4113 patients were included. For patients undergoing simple knee arthroscopic surgery, LMWH prophylaxis did not bring a significant reduction in the risk of major VTE (RR, 1.00 [95% CI, 0.37-2.67]; > .99) and all VTE (RR, 0.63 [95% CI, 0.31-1.29]; = .21) and did not increase the risk of major BEs (RR, 0.98 [95% CI, 0.06-15.72]; = .99) but did have a higher risk of all BEs (RR, 1.64 [95% CI, 1.18-2.28]; = .003) in comparison with non-LMWH prophylaxis. For patients undergoing ACLR, LMWH prophylaxis was associated with a significantly lower rate of major VTE (RR, 0.23 [95% CI, 0.12-0.43]; < .001) and all VTE (RR, 0.22 [95% CI, 0.06-0.73]; = .01) but no increase in major BEs (RR, 1.80 [95% CI, 0.19-17.25]; = .61) and all BEs (RR, 1.12 [95% CI, 0.72-1.74]; = .61) in comparison with non-LMWH prophylaxis.
Compared with non-LMWH treatment, LMWH had no significant efficacy in preventing VTE in patients undergoing simple knee arthroscopic surgery but increased the risk of BEs. However, LMWH had significant efficacy in preventing VTE for patients mainly undergoing ACLR and did not increase the risk of BEs.
低分子肝素（LMWH）血栓预防广泛用于降低主要矫形手术后血栓形成的风险。然而，其在膝关节镜手术中的效果和安全性仍存在争议。
通过对随机对照试验（RCT）进行荟萃分析，评估 LMWH 预防膝关节镜手术和前交叉韧带重建（ACLR）后症状性静脉血栓栓塞症（VTE）的疗效和安全性。
荟萃分析。
作者检索了 MEDLINE、Embase、Cochrane 中央对照试验注册库（CENTRAL）、ClinicalTrials.gov 和 Web of Science 从成立到 2017 年 6 月 30 日的所有研究。所有入选研究分为 2 个亚组：单纯膝关节镜手术和 ACLR。主要疗效和安全性终点分别为主要 VTE 和主要出血事件（BE）的发生率。次要疗效和安全性终点分别为所有 VTE 和所有 BE 的发生率。使用 Review Manager 5.3 计算相对风险（RR）和 95%置信区间（CI）。
共纳入 8 项 RCT 共 4113 例患者。对于单纯膝关节镜手术患者，LMWH 预防并未显著降低主要 VTE（RR，1.00 [95% CI，0.37-2.67]；>.99）和所有 VTE（RR，0.63 [95% CI，0.31-1.29]；=.21）的风险，也未增加主要 BE（RR，0.98 [95% CI，0.06-15.72]；=.99）的风险，但所有 BE（RR，1.64 [95% CI，1.18-2.28]；=.003）的风险更高与非 LMWH 预防相比。对于接受 ACLR 的患者，LMWH 预防与显著较低的主要 VTE（RR，0.23 [95% CI，0.12-0.43]；<.001）和所有 VTE（RR，0.22 [95% CI，0.06-0.73]；=.01）的发生率相关，但主要 BE（RR，1.80 [95% CI，0.19-17.25]；=.61）和所有 BE（RR，1.12 [95% CI，0.72-1.74]；=.61）的发生率无差异非 LMWH 预防。
与非 LMWH 治疗相比，LMWH 对单纯膝关节镜手术患者预防 VTE 无明显疗效，但增加了 BE 的风险。然而，LMWH 对主要接受 ACLR 的患者有显著的 VTE 预防作用，且不增加 BE 的风险。
