Riehl John T, Embry Noah J, Zeter Daniel G, Potgieter Cornelis J, Box McKenna W
Medical City UNT/TCU Orthopaedic Surgery Residency Program Director, 3325 Medpark Dr, Denton, TX, 76210, USA.
Texas Christian University Anne Burnett Marion School of Medicine, Fort Worth, TX, USA.
Arch Orthop Trauma Surg. 2024 Dec 23;145(1):86. doi: 10.1007/s00402-024-05675-x.
Low rates of venous thromboembolism (VTE) have been found in patients with isolated orthopaedic trauma below the knee. Many surgeons routinely provide chemical thromboprophylaxis in these injuries, however. This is not without inherent risks, and this remains a controversial topic in perioperative care in orthopaedic trauma. This systematic review and meta-analysis was performed to look at rates of VTE in patients with isolated orthopaedic fractures below the knee, grouped by whether they received chemical prophylaxis versus no chemical prophylaxis.
A systematic review was performed comparing VTE with and without chemical thromboprophylaxis following isolated orthopaedic fracture below the knee. A chi-square analysis was then performed on data including patients who received chemical prophylaxis versus those who did not from all 25 included articles. The articles were grouped according to type of study, such as observational versus randomized controlled trial (RCT), and then further subdivided according to surgical intervention status, and whether routine screening for thromboembolism was utilized to diagnose. Risk of bias assessment was performed using the ROBINS-I criteria for cohort studies and the Cochrane RoB 2 tool for randomized controlled trials. A random effects pooled logistic regression and Fisher's exact tests were then performed.
222,188 patients were found from 25 articles. Chemical prophylaxis was given to 8,666 patients, and VTE was reported in 347 cases (4.0%). 213,522 patients did not receive chemical prophylaxis, and VTE was reported in 2,185 (1.02%) (χ (1, n = 222,188) = 656.8, p < .00001). Pooled logistic regression revealed that patients receiving prophylaxis were 0.5 times less likely to develop VTE. With a calculated population baseline risk of 1.5% for developing VTE, the number needed to treat (NNT) with chemical prophylaxis is 134 to prevent 1 VTE after fracture below the knee.
In patients with isolated orthopaedic trauma below the knee, indiscriminate use of chemical VTE prophylaxis is not recommended due to the lack of significant benefit and high NNT.
Level III.
在单纯膝下骨科创伤患者中，静脉血栓栓塞症（VTE）的发生率较低。然而，许多外科医生在处理这些损伤时通常会常规给予化学性血栓预防措施。这并非没有内在风险，并且在骨科创伤围手术期护理中这仍然是一个有争议的话题。本系统评价和荟萃分析旨在观察单纯膝下骨科骨折患者的VTE发生率，根据是否接受化学预防措施进行分组。
进行了一项系统评价，比较膝下骨科骨折后接受和未接受化学性血栓预防措施的患者的VTE情况。然后对包括所有25篇纳入文章中接受化学预防措施的患者与未接受化学预防措施的患者的数据进行卡方分析。文章根据研究类型进行分组，如观察性研究与随机对照试验（RCT），然后根据手术干预状态以及是否采用常规血栓栓塞筛查进行诊断进一步细分。使用队列研究的ROBINS - I标准和随机对照试验的Cochrane RoB 2工具进行偏倚风险评估。然后进行随机效应合并逻辑回归和Fisher精确检验。
从25篇文章中找到222,188例患者。8666例患者接受了化学预防措施，其中347例（4.0%）报告发生VTE。213,522例患者未接受化学预防措施，其中2185例（1.02%）报告发生VTE（χ(1, n = 222,188) = 656.8，p <.00001）。合并逻辑回归显示，接受预防措施的患者发生VTE的可能性降低0.5倍。计算得出发生VTE的总体基线风险为1.5%，膝下骨折后进行化学预防措施预防1例VTE所需治疗人数（NNT）为134。
对于单纯膝下骨科创伤患者，由于缺乏显著益处且NNT较高，不建议不加区分地使用化学性VTE预防措施。
三级。
