Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8P 1H6, Canada.
Knee Surg Sports Traumatol Arthrosc. 2022 Jul;30(7):2364-2376. doi: 10.1007/s00167-021-06857-5. Epub 2022 Feb 3.
The primary aim of this network meta-analysis (NMA) is to compare the incidence of venous thromboembolisms (VTE) and bleeding risk following the use of pharmacological and non-pharmacological thromboprophylaxis for arthroscopic knee surgery (AKS). This study assumed the null hypothesis which was that there will be no difference in the incidence of VTE and bleeding risk when comparing no treatment, pharmacological treatment, and non-pharmacological treatment for preventing VTE events following AKS.
A systematic electronic search of CENTRAL, Medline, Embase, and ClinicalTrials.gov was carried out. All English language prospective randomized clinical trials published from date of database inception to November 21, 2021 were eligible for inclusion. All papers addressing arthroscopic knee surgery were eligible for inclusion regardless of timing of surgery, operation, surgical technique, or rehabilitation. Multiple random effects NMAs were conducted to compare all treatments for each outcome. The primary outcome was the incidence of pulmonary embolism (PE) and secondary outcomes consisted of overall deep vein thrombosis (DVT), symptomatic DVT, asymptomatic DVT, and all-cause mortality. Adverse outcomes consisted of major and minor bleeding, as well as adverse events.
A total of nine studies with 4526 patients were included for analysis. There were 1054 patients in the no treatment/placebo group (NT/Placebo), 1646 patients in the graduated compression stockings, 810 patients in the extended-duration (> 10 days) low molecular weight heparin (Ext-LMWH) group, 650 patients in the short-duration (< 10 days) LMWH group (Short-LMWH), and 356 patients in the rivaroxaban group. GCS, Ext-LMWH, Short-LMWH and rivaroxaban all demonstrated low risks of PE, symptomatic DVT, asymptomatic DVT, combined DVT and all-cause mortality. Similarly, all interventions demonstrated a low risk of major bleeding.
There is no significant difference in the risk reduction of PEs, symptomatic DVTs, major/minor bleeding, and/or all-cause mortality when using LWMH (including short or extended regimens), rivaroxaban, graduated compression stockings or no treatment following arthroscopic knee surgery. Future primary research on the efficacy of thromboprophylaxis following arthroscopic knee surgery should stratify outcomes based on key patient (i.e., age, sex, comorbidities) and surgical (i.e., major vs. minor surgery) characteristics and should include acetylsalicylic acid as an intervention.
I, network meta-analysis of Level I studies.
本网状荟萃分析（NMA）的主要目的是比较关节镜膝关节手术（AKS）后使用药物和非药物血栓预防措施的静脉血栓栓塞（VTE）发生率和出血风险。本研究假设零假设，即在比较 AKS 后预防 VTE 事件时，不治疗、药物治疗和非药物治疗之间在 VTE 和出血风险方面没有差异。
对 CENTRAL、Medline、Embase 和 ClinicalTrials.gov 进行系统的电子检索。所有从数据库成立日期到 2021 年 11 月 21 日发表的英文前瞻性随机临床试验均符合纳入标准。所有涉及关节镜膝关节手术的论文均符合纳入标准，无论手术时间、手术、手术技术或康复如何。进行了多次随机效应 NMA 以比较每种结局的所有治疗方法。主要结局是肺栓塞（PE）的发生率，次要结局包括总深静脉血栓形成（DVT）、症状性 DVT、无症状性 DVT 和全因死亡率。不良结局包括大出血和小出血以及不良事件。
共纳入 9 项研究，共计 4526 例患者。不治疗/安慰剂组（NT/Placebo）1054 例，梯度压力袜组 1646 例，延长疗程（>10 天）低分子肝素（Ext-LMWH）组 810 例，短疗程（<10 天）低分子肝素（Short-LMWH）组 650 例，利伐沙班组 356 例。GCS、Ext-LMWH、Short-LMWH 和 rivaroxaban 均显示出较低的 PE、症状性 DVT、无症状性 DVT、联合 DVT 和全因死亡率风险。同样，所有干预措施均显示出较低的大出血风险。
在关节镜膝关节手术后使用 LMWH（包括短疗程或长疗程）、利伐沙班、梯度压力袜或不治疗时，PE、症状性 DVT、大出血/小出血和/或全因死亡率的降低风险没有显著差异。未来关于关节镜膝关节手术后血栓预防疗效的主要研究应根据关键患者（即年龄、性别、合并症）和手术（即大手术与小手术）特征对结局进行分层，并应将乙酰水杨酸作为一种干预措施纳入研究。
I，一级研究的网络荟萃分析。
