Mirghaderi Peyman, Pahlevan-Fallahy Mohammad-Taha, Rahimzadeh Payman, Habibi Mohammad Amin, Pourjoula Fatemeh, Azarboo Alireza, Moharrami Alireza
Surgical Research Society (SRS), Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
North Jamalzadeh St. Imam Khomeini Hospital Complex (IKHC), Tehran, Iran.
J Orthop Surg Res. 2024 Dec 19;19(1):848. doi: 10.1186/s13018-024-05356-w.
The adverse effects of aspirin are dose-dependent, and there is controversy surrounding the use of low-dose (LD) aspirin to prevent venous thromboembolism (VTE) following total joint arthroplasty (TJA). This meta-analysis sought to compare the efficacy and complication rate of low-dose (162 mg per day) versus high-dose (HD, 650 mg per day) aspirin after TJA surgery.
In four main databases, we searched from inception until September 2024 for articles comparing the rate of VTE following TJA(TKA/THA) using only aspirin chemoprophylaxis with different dosages. We meta-analyzed and compared the VTE and complication rates of LD aspirin (162 mg per day) with HD aspirin (650 mg per day) and presented our results as odds ratio (ORs) in forest plot diagrams.
There were 14 eligible studies, comprising 43,518 patients in the LD group and 62,645 patients in the HD group. DVT (OR: 1.37, CI: 0.93-2.02, P = 0.11) and PE (OR: 1.86, CI: 0.73-4.72, P = 0.19) rates were similar between the groups. However, taking VTE as the total number of cases with DVT or PE, the incidence was significantly higher in the HD group than in the LD group (OR:1.53, CI: 1.17-2.00, P = 0.002). HD also had a significantly higher rate of PJI (OR:2.68 CI:1.5-4.6 P = 0.001), but gastrointestinal bleeding (GIB) was similar between the two groups (OR: 0.97, CI: 0.42-2.22, P = 0.95).
The findings suggest that LD aspirin may be a viable option for VTE chemoprophylaxis following TJA, potentially offering comparable efficacy with a lower risk of PJI compared to HD aspirin regimens.
Therapeutic Level II.
阿司匹林的不良反应具有剂量依赖性，对于全关节置换术（TJA）后使用低剂量（LD）阿司匹林预防静脉血栓栓塞症（VTE）存在争议。本荟萃分析旨在比较TJA手术后低剂量（每日162毫克）与高剂量（HD，每日650毫克）阿司匹林的疗效和并发症发生率。
在四个主要数据库中，我们检索了从数据库创建至2024年9月的文章，这些文章比较了仅使用不同剂量阿司匹林进行化学预防的TJA（全膝关节置换术/全髋关节置换术）后VTE的发生率。我们对低剂量阿司匹林（每日162毫克）和高剂量阿司匹林（每日650毫克）的VTE和并发症发生率进行了荟萃分析和比较，并在森林图中以优势比（OR）展示我们的结果。
有14项符合条件的研究，LD组有43518例患者，HD组有62645例患者。两组之间的深静脉血栓形成（OR：1.37，CI：0.93 - 2.02，P = 0.11）和肺栓塞（OR：1.86，CI：0.73 - 4.72，P = 0.19）发生率相似。然而，以VTE为深静脉血栓形成或肺栓塞的病例总数，HD组的发生率显著高于LD组（OR：1.53，CI：1.17 - 2.00，P = 0.002）。HD组的假体周围感染（PJI）发生率也显著更高（OR：2.68，CI：1.5 - 4.6，P = 0.001），但两组之间的胃肠道出血（GIB）情况相似（OR：0.97，CI：0.42 - 2.22，P = 0.95）。
研究结果表明，LD阿司匹林可能是TJA后VTE化学预防的一个可行选择，与HD阿司匹林方案相比，可能具有相当的疗效且假体周围感染风险较低。
治疗性II级。
