Wei Qingqing, Sun Jing, Bai Yusuo, Meng Chang, Miao Guobin, Liu Peng, Wang Haijun
Department of Critical Care Medicine, Emergency General Hospital, Beijing, 100028, PR China.
Department of Vascular Surgery, Chuiyangliu Hospital Affiliated to Tsinghua University, Beijing, 100022, PR China.
Open Med (Wars). 2023 Aug 26;18(1):20230760. doi: 10.1515/med-2023-0760. eCollection 2023.
Low molecular weight heparin (LMWH) is often used to prevent perioperative venous thrombosis after surgery, but aspirin is also recommended by academics. Studies were searched in electronic databases until February 24, 2023. We performed a meta-analysis to evaluate the safety and efficacy of aspirin and LMWH for venous thromboembolism (VTE) prophylaxis in patients after orthopedic surgery. The outcomes were death from any causes, deep vein thrombosis (DVT), pulmonary embolism (PE), etc. This study was registered with INPLASY, number 202320117. Six randomized controlled trials enrolled 13,851 patients with postoperative joint surgery. The risk of DVT was comparable between the two groups when aspirin was combined with mechanical devices (RR 0.61 [95% CI 0.27-1.39], ² = 62%, = 0.24). No significant differences in all cause death, PE, wound infection, and wound complication were found between the aspirin and LMWH groups. In this meta-analysis, the mortality rate was comparable between the aspirin and LMWH groups. However, aspirin alone had a higher risk of DVT than LMWH. Based on the results of this meta-analysis, we suggest aspirin combined with mechanical devices for VTE prophylaxis in patients after orthopedic surgery.
低分子量肝素（LMWH）常用于预防术后围手术期静脉血栓形成，但学术界也推荐使用阿司匹林。截至2023年2月24日，我们在电子数据库中检索了相关研究。我们进行了一项荟萃分析，以评估阿司匹林和低分子量肝素在骨科手术后患者中预防静脉血栓栓塞（VTE）的安全性和有效性。观察指标包括任何原因导致的死亡、深静脉血栓形成（DVT）、肺栓塞（PE）等。本研究已在INPLASY注册，注册号为202320117。六项随机对照试验纳入了13851例接受关节手术后的患者。当阿司匹林与机械装置联合使用时，两组之间DVT的风险相当（风险比0.61 [95%可信区间0.27 - 1.39]，I² = 62%，P = 0.24）。阿司匹林组和低分子量肝素组在全因死亡、PE、伤口感染和伤口并发症方面未发现显著差异。在这项荟萃分析中，阿司匹林组和低分子量肝素组的死亡率相当。然而，单独使用阿司匹林时DVT的风险高于低分子量肝素。基于这项荟萃分析的结果，我们建议在骨科手术后患者中使用阿司匹林联合机械装置预防VTE。
