Murray D W, Britton A R, Bulstrode C J
Nuffield Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre, Headington, Oxford, UK.
J Bone Joint Surg Br. 1996 Nov;78(6):863-70. doi: 10.1302/0301-620x78b6.6714.
The recommendation that patients having a total hip replacement should receive pharmacological thromboprophylaxis is based on the belief that fatal pulmonary embolism is common, and that prophylaxis will decrease the death rate. To investigate these assumptions we performed a meta-analysis of all studies on hip replacement which included information about death or fatal pulmonary embolism. A total of 130 000 patients was included. The studies were so varied in content and quality that the results of our analysis must be interpreted with some caution. The fatal pulmonary embolism rate was 0.1% to 0.2% even in patients who received no prophylaxis. This is an order of magnitude lower than that which is generally quoted, and therefore the potential benefit of prophylaxis is small and may not justify the risks. To balance the risks and benefits we must consider the overall death rate. This was 0.3% to 0.4%, and neither heparin nor any other prophylactic agent caused a significant decrease. Our study demonstrates that there is not enough evidence in the literature to conclude that any form of pharmacological thromboprophylaxis decreases the death rate after total hip replacement. For this reason guidelines which recommend their routine use to prevent death after hip replacement are not justified.
致命性肺栓塞很常见，且预防措施将降低死亡率。为了研究这些假设，我们对所有关于髋关节置换的研究进行了荟萃分析，这些研究包含了有关死亡或致命性肺栓塞的信息。总共纳入了130000名患者。这些研究在内容和质量上差异很大，因此我们分析的结果必须谨慎解读。即使在未接受预防措施的患者中，致命性肺栓塞率也为0.1%至0.2%。这比通常引用的数字低一个数量级，因此预防的潜在益处很小，可能无法证明其风险是合理的。为了平衡风险和益处，我们必须考虑总体死亡率。总体死亡率为0.3%至0.4%，肝素或任何其他预防药物均未导致显著降低。我们的研究表明，文献中没有足够的证据得出任何形式的药物性血栓预防可降低全髋关节置换术后死亡率的结论。因此，推荐常规使用这些措施来预防髋关节置换术后死亡的指南是不合理的。
