Salman Loay A, Altahtamouni Seif B, Khatkar Harman, Al-Ani Abdallah, Hameed Shamsi, Alvand Abtin
Department of Orthopaedic Surgery, Surgical Specialty Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
Royal London Hospital, London, UK.
Knee Surg Sports Traumatol Arthrosc. 2025 May;33(5):1605-1616. doi: 10.1002/ksa.12456. Epub 2024 Sep 3.
The purpose of this study was to assess the efficacy of aspirin versus low-molecular-weight heparin (LMWH) in preventing venous thromboembolism (VTE) following hip and knee arthroplasty.
PubMed/Medline, Embase, Cochrane Library and Google Scholar databases were searched from inception till June 2024 for original trials investigating the outcomes of aspirin versus LMWH in hip and knee arthroplasty. The primary outcome was VTE. Secondary outcomes included minor and major bleeding events, and postoperative mortality within 90 days. This review was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
A total of 7 randomized controlled trials with 12,134 participants were included. The mean ages for the aspirin and LMWH cohorts were 66.6 (57.6-69.0) years and 66.8 (57.9-68.9) years, respectively. There was no statistically significant difference in the overall risk of VTE between the aspirin and the LMWH cohorts (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.48-1.89; p: 0.877). A subanalysis based on the specific VTE entity (pulmonary embolism [PE] or deep venous thrombosis) showed a significantly higher PE risk for patients receiving aspirin than the LMWH cohort (OR: 1.79; 95% CI: 1.11-2.89; p: 0.017). There was no difference in minor (OR: 0.64; 95% CI: 0.40-1.04; p: 0.072) and major bleeding (OR: 0.77; 95% CI: 0.40-1.47; p: 0.424) episodes across both groups. Furthermore, subanalysis among the total knee arthroplasty group showed that the aspirin cohort was significantly more likely to suffer VTEs than their LMWH counterparts (OR: 1.55; 95% CI: 1.21-1.98; p < 0.001).
This study demonstrated a significantly higher risk of PE among patients receiving aspirin compared to LMWH following hip or knee arthroplasty for osteoarthritis. Aspirin was associated with a significantly higher overall VTE risk among patients undergoing knee arthroplasty, in particular. This might suggest the inferiority of aspirin compared to LMWH in preventing VTE following such procedures.
Level I.
本研究旨在评估阿司匹林与低分子肝素（LMWH）在预防髋膝关节置换术后静脉血栓栓塞症（VTE）方面的疗效。
检索PubMed/Medline、Embase、Cochrane图书馆和谷歌学术数据库，从建库至2024年6月，查找关于阿司匹林与LMWH在髋膝关节置换术中疗效对比的原始试验。主要结局为VTE。次要结局包括轻微和严重出血事件以及90天内的术后死亡率。本综述按照系统评价和Meta分析的首选报告项目指南进行。
共纳入7项随机对照试验，12134名参与者。阿司匹林组和LMWH组的平均年龄分别为66.6（57.6 - 69.0）岁和66.8（57.9 - 68.9）岁。阿司匹林组和LMWH组在VTE总体风险上无统计学显著差异（优势比[OR]：0.95；95%置信区间[CI]：0.48 - 1.89；p：0.877）。基于特定VTE类型（肺栓塞[PE]或深静脉血栓形成）的亚组分析显示，接受阿司匹林治疗的患者发生PE的风险显著高于LMWH组（OR：1.79；95% CI：1.11 - 2.89；p：0.017）。两组在轻微出血（OR：0.64；95% CI：0.40 - 1.04；p：0.072）和严重出血（OR：0.77；95% CI：0.40 - 1.47；p：0.424）事件方面无差异。此外，全膝关节置换术组的亚组分析表明，阿司匹林组发生VTE的可能性显著高于LMWH组（OR：1.55；95% CI：1.21 - 1.98；p < 0.001）。
本研究表明，与LMWH相比，骨关节炎患者在髋膝关节置换术后接受阿司匹林治疗发生PE的风险显著更高。特别是在接受膝关节置换术的患者中，阿司匹林与更高的总体VTE风险相关。这可能表明在预防此类手术后的VTE方面，阿司匹林不如LMWH。
I级。
