Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada.
Oncology Department, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK.
Bone Joint J. 2020 Dec;102-B(12):1743-1751. doi: 10.1302/0301-620X.102B12.BJJ-2019-1136.R3.
Malignancy and surgery are risk factors for venous thromboembolism (VTE). We undertook a systematic review of the literature concerning the prophylactic management of VTE in orthopaedic oncology patients.
MEDLINE (PubMed), EMBASE (Ovid), Cochrane, and CINAHL databases were searched focusing on VTE, deep vein thrombosis (DVT), pulmonary embolism (PE), bleeding, or wound complication rates.
In all, 17 studies published from 1998 to 2018 met the inclusion criteria for the systematic review. The mean incidence of all VTE events in orthopaedic oncology patients was 10.7% (1.1% to 27.7%). The rate of PE was 2.4% (0.1% to 10.6%) while the rate of lethal PE was 0.6% (0.0% to 4.3%). The overall rate of DVT was 8.8% (1.1% to 22.3%) and the rate of symptomatic DVT was 2.9% (0.0% to 6.2%). From the studies that screened all patients prior to hospital discharge, the rate of asymptomatic DVT was 10.9% (2.0% to 20.2%). The most common risk factors identified for VTE were endoprosthetic replacements, hip and pelvic resections, presence of metastases, surgical procedures taking longer than three hours, and patients having chemotherapy. Mean incidence of VTE with and without chemical prophylaxis was 7.9% (1.1% to 21.8%) and 8.7% (2.0% to 23.4%; p = 0.11), respectively. No difference in the incidence of bleeding or wound complications between prophylaxis groups was reported.
Current evidence is limited to guide clinicians. It is our consensus opinion, based upon logic and deduction, that all patients be considered for both mechanical and chemical VTE prophylaxis, particularly in high-risk patients (pelvic or hip resections, prosthetic reconstruction, malignant diagnosis, presence of metastases, or surgical procedures longer than three hours). Additionally, the surgeon must determine, in each patient, if the risk of haemorrhage outweighs the risk of VTE. No individual pharmacological agent has been identified as being superior in the prevention of VTE events. Cite this article: 2020;102-B(12)1743:-1751.
恶性肿瘤和手术是静脉血栓栓塞症（VTE）的危险因素。我们对骨科肿瘤患者 VTE 预防管理的相关文献进行了系统回顾。
我们在 MEDLINE（PubMed）、EMBASE（Ovid）、Cochrane 和 CINAHL 数据库中检索了与 VTE、深静脉血栓形成（DVT）、肺栓塞（PE）、出血或伤口并发症发生率相关的文献。
共有 17 项自 1998 年至 2018 年发表的研究符合系统综述的纳入标准。在骨科肿瘤患者中，所有 VTE 事件的发生率平均为 10.7%（1.1%至 27.7%）。PE 的发生率为 2.4%（0.1%至 10.6%），而致死性 PE 的发生率为 0.6%（0.0%至 4.3%）。DVT 的总发生率为 8.8%（1.1%至 22.3%），症状性 DVT 的发生率为 2.9%（0.0%至 6.2%）。在对所有患者在出院前进行筛查的研究中，无症状 DVT 的发生率为 10.9%（2.0%至 20.2%）。确定的 VTE 最常见的危险因素包括内置假体、髋关节和骨盆切除术、转移灶存在、手术时间超过 3 小时以及化疗。有和没有化学预防措施的 VTE 发生率分别为 7.9%（1.1%至 21.8%）和 8.7%（2.0%至 23.4%；p=0.11）。预防组之间报告的出血或伤口并发症发生率无差异。
目前的证据还不足以指导临床医生。基于逻辑和推理，我们的共识是，所有患者都应考虑使用机械和化学 VTE 预防措施，特别是高危患者（骨盆或髋关节切除术、假体重建、恶性肿瘤诊断、转移灶存在或手术时间超过 3 小时）。此外，外科医生必须在每位患者中确定出血风险是否超过 VTE 风险。目前还没有发现哪种单一的药物在预防 VTE 事件方面具有优势。引用本文：2020；102-B（12）1743：-1751。
