Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
Thromb Res. 2021 Feb;198:86-92. doi: 10.1016/j.thromres.2020.11.033. Epub 2020 Dec 2.
Although chemoprophylaxis against venous thromboembolism (VTE) after Total Joint Arthroplasty (TJA) is commonly practiced, epidemiology studies have shown Asians have a much lower incidence of VTE. The authors aim to investigate if chemoprophylaxis is really necessary in the Asian population undergoing TJA.
Literature searched was conducted for randomized controlled trials or quasi-experimental studies investigating efficacy and/or safety of chemoprophylaxis for TJA without language restrictions. Network meta-analysis, comparing the incidence of 'VTE to be treated', 'VTE not to be treated', 'Minor bleeding', and 'Major bleeding' amongst the different interventions was performed using multivariate meta-regression model.
38 studies (11,769 patients) were included. Total incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) were 14.2% and 0.73% respectively. For outcome on efficiency, edoxaban, low-molecular-weight-heparin (LMWH), fondaparinux, and enoxaparin showed significantly lower Risk Ratio (RR) for 'VTE to be treated' compared to Control/Placebo. Although no interventions showed increased incidence of major bleeding, LMWH and fondaparinux showed higher RR for minor bleeding. Enoxaparin displayed the best efficacy and safety profile. Total incidence of symptomatic DVT in studies involving enoxaparin was 1.98% (1.07% in patients who received enoxaparin, 2.92% in Control/Placebo). Total incidence of proximal DVT was 2.93% (2.67% in patients who received enoxaparin, 3.11% in Control/Placebo).
Asian population has a much lower incidence of VTE events after TJA compared to the Western population. Although Enoxaparin is still efficacious in reducing symptomatic and proximal DVT after TJA, its benefit-to-risk ratio is much lower than described in the Western literature.
尽管全膝关节置换术（TJA）后预防性使用抗静脉血栓栓塞药物（VTE）是常规做法，但流行病学研究表明亚洲人 VTE 的发生率低得多。作者旨在研究 TJA 后亚洲人群是否真的需要预防性使用抗血栓药物。
检索了随机对照试验或准实验研究，这些研究无语言限制地调查了 TJA 中抗血栓药物的疗效和/或安全性。使用多变量荟萃回归模型对不同干预措施之间的“需要治疗的 VTE”、“无需治疗的 VTE”、“轻微出血”和“大出血”发生率进行了网络荟萃分析。
共纳入 38 项研究（11769 例患者）。深静脉血栓形成（DVT）和肺栓塞（PE）的总发生率分别为 14.2%和 0.73%。在疗效方面，依度沙班、低分子肝素（LMWH）、磺达肝癸钠和依诺肝素与对照组/安慰剂相比，“需要治疗的 VTE”的风险比（RR）显著降低。虽然没有干预措施显示大出血发生率增加，但 LMWH 和磺达肝癸钠的轻微出血 RR 较高。依诺肝素具有最佳的疗效和安全性。依诺肝素组的症状性 DVT 总发生率为 1.98%（接受依诺肝素的患者为 1.07%，对照组/安慰剂为 2.92%）。近端 DVT 的总发生率为 2.93%（接受依诺肝素的患者为 2.67%，对照组/安慰剂为 3.11%）。
与西方人群相比，亚洲人群 TJA 后 VTE 事件的发生率要低得多。虽然依诺肝素在减少 TJA 后症状性和近端 DVT 方面仍然有效，但它的获益-风险比远低于西方文献中的描述。
