Medical Student, School of Medicine, The University of Texas Medical Branch, Galveston, TX.
Professor, College of Medicine, Department of Surgery, Texas A&M University Health Science Center, Round Rock, TX; Chief, Section of Podiatry, Department of Surgery, Central Texas Veterans Affairs Health Care System, Temple, TX; Podiatry Specialist, Department of Surgery, Baylor Scott & White Health, Temple, TX.
J Foot Ankle Surg. 2021 Sep-Oct;60(5):1014-1022. doi: 10.1053/j.jfas.2021.03.010. Epub 2021 Mar 27.
This systematic review was conducted to investigate the effects of currently used chemoprophylactic modalities to assess concerns regarding their usage. Preventive benefits of thromboprophylaxis were weighed against potential complications in orthopedic and trauma patients. The Ovid MEDLINE® database was used to identify relevant studies. The authors independently screened the initial study articles by title and abstract, eliminating articles not dealing with venous thromboembolism (VTE) chemoprophylaxis in orthopedic or trauma populations. The remaining articles were assessed for eligibility through full-text analysis. The analyzed studies within this review suggested that Factor X inhibitors and direct oral anticoagulants hold promise as safe and potentially more effective thromboprophylactic entities when compared to low molecular weight heparin in trauma and orthopedic patients. Thromboprophylaxis had little to no effect on major bleeding incidence, although we could not definitively conclude there was no effect on overall bleeding. Early thromboprophylaxis, especially when identifiable risk factors are present, can improve VTE prevention without changing major bleeding rates. Additionally, we could not conclude whether extended prophylaxis affects VTE incidence, although it seemed to have no effect on major bleeding. Finally, we determined that thromboprophylaxis in the lower extremity trauma population is questionable without the presence of underlying risk factors.
这篇系统评价旨在研究目前用于评估其使用情况的化学预防方法的效果。权衡了骨科和创伤患者中血栓预防的益处与潜在并发症。使用 Ovid MEDLINE®数据库来确定相关研究。作者通过标题和摘要独立筛选了初步的研究文章，排除了未涉及骨科或创伤人群中静脉血栓栓塞症（VTE）化学预防的文章。通过全文分析评估了其余文章的适用性。本综述中的分析研究表明，与低分子肝素相比，X 因子抑制剂和直接口服抗凝剂在创伤和骨科患者中作为安全且潜在更有效的血栓预防药物具有前景。血栓预防对大出血发生率几乎没有影响，尽管我们不能确定对总体出血没有影响。早期血栓预防，特别是在存在可识别的危险因素时，可以在不改变大出血发生率的情况下改善 VTE 的预防。此外，我们无法确定是否延长预防措施会影响 VTE 的发生率，尽管它似乎对大出血没有影响。最后，我们确定，如果没有潜在的危险因素，下肢创伤人群的血栓预防是值得怀疑的。
