Department of Orthopaedics, The First College of Clinical Medical Science, China Three Gorges University, Yichang, China.
Department of Orthopaedics, Yichang Central People's Hospital, Yichang, China.
Medicine (Baltimore). 2023 Oct 20;102(42):e35602. doi: 10.1097/MD.0000000000035602.
Major orthopedic surgery, including hip and knee replacement and lower extremity trauma fractures surgery, is associated with a high risk of venous thromboembolism (VTE), especially proximal deep vein thrombosis (DVT), and pulmonary embolism (PE), and is linked with high morbidity and mortality rates. Chemical anticoagulation is routinely used to prevent VTE, with previous meta-analyses reporting on the efficacy and safety of aspirin and other anticoagulants, however, opinions are divided. In the past 2 years, several large randomized controlled trials have been published, therefore, we reanalyzed aspirin efficacy and safety when compared with other anticoagulants in preventing VTE in major orthopedic surgery.
Using PubMed, The Cochrane Library, Embase, and Web of Science databases, we conducted a RCT search in August 2023. The main outcomes included VTE, proximal DVT or PE. Additional outcomes included bleeding events, wound complications, wound infections, blood transfusions, and death events.
In total, 17 eligible articles, involving 29,522 patients (15,253 aspirin vs 14,269 other anticoagulant cases), were included. Primary outcomes showed that VTE incidence was more high in the aspirin group when compared with other anticoagulants (risk ratio [RR] = 1.45, 95% confidence interval [CI] = 1.18-1.77, P = .0004) and proximal in the aspirin group the DVT and/or PE incidence was significantly higher in the aspirin group when compared with other anticoagulants (RR = 1.19, 95% CI = 1.02-1.39, P = .03). No significant secondary outcome differences were identified in the aspirin group when compared with other anticoagulants (bleeding events [RR] = 0.83, 95% CI = 0.63-1.10, P = .20); wound complications (RR = 0.45, 95% CI = 0.20-1.04, P = .06); wound infection (RR = 1.08, 95% CI = 0.85-1.38, P = .53); blood transfusion events (RR = 1.00, 95% CI = 0.84-1.19, P = 1.00) and death events (RR = 1.11, 95% CI = 0.78-1.57, P = .55).
Our updated meta-analysis showed that aspirin was inferior to when compared with other anticoagulants in VTE-related orthopedic major surgery, including proximal DVT and/or PE, and was more likely to form VTE. No differences between groups were identified for bleeding, wound complications, wound infections, transfusion, or death events.
包括髋关节和膝关节置换以及下肢创伤骨折手术在内的主要骨科手术存在发生静脉血栓栓塞（VTE）的高风险，尤其是近端深静脉血栓（DVT）和肺栓塞（PE），并且与高发病率和死亡率相关。 化学抗凝通常用于预防 VTE，此前的荟萃分析报告了阿司匹林和其他抗凝剂的疗效和安全性，但意见不一。 在过去的 2 年中，已经发表了几项大型随机对照试验，因此，我们重新分析了阿司匹林在预防主要骨科手术中的 VTE 方面与其他抗凝剂相比的疗效和安全性。
使用 PubMed、Cochrane 图书馆、Embase 和 Web of Science 数据库，我们于 2023 年 8 月进行了 RCT 检索。主要结局包括 VTE、近端 DVT 或 PE。其他结局包括出血事件、伤口并发症、伤口感染、输血和死亡事件。
共纳入 17 篇符合条件的文章，涉及 29522 例患者（阿司匹林组 15253 例，其他抗凝剂组 14269 例）。主要结局显示，与其他抗凝剂相比，阿司匹林组的 VTE 发生率更高（风险比[RR] = 1.45，95%置信区间[CI] = 1.18-1.77，P =.0004），且阿司匹林组近端 DVT 和/或 PE 的发生率也明显更高（RR = 1.19，95%CI = 1.02-1.39，P =.03）。与其他抗凝剂相比，阿司匹林组在次要结局方面没有明显差异（出血事件[RR] = 0.83，95%CI = 0.63-1.10，P =.20）；伤口并发症（RR = 0.45，95%CI = 0.20-1.04，P =.06）；伤口感染（RR = 1.08，95%CI = 0.85-1.38，P =.53）；输血事件（RR = 1.00，95%CI = 0.84-1.19，P = 1.00）和死亡事件（RR = 1.11，95%CI = 0.78-1.57，P =.55）。
我们的更新荟萃分析显示，与其他抗凝剂相比，阿司匹林在 VTE 相关的主要骨科手术中效果较差，包括近端 DVT 和/或 PE，并且更有可能形成 VTE。两组在出血、伤口并发症、伤口感染、输血或死亡事件方面没有差异。
