PDF(Pubmed)
Abstract：
Venous thromboembolism (VTE) is a serious complication that can arise during and after hospitalization, particularly following surgery under general anaesthesia. Particularly at risk are major orthopaedic surgical procedures such as elective knee or hip replacement and the treatment of hip fractures. In these patients, current guidelines recommend (low or low-moderate level of evidence) aspirin as a possible alternative to anticoagulant therapy for the prophylaxis of long-term venous thromboembolism after an initial period with anticoagulant drugs. Several randomized trials and meta-analyses demonstrate no significant differences in the risk of VTE when comparing aspirin with anticoagulants. However, it must be considered that most recommendations are based on elective orthopaedic surgery and that trials after fractures have excluded patients at high thrombotic risk. Consequently, the overall incidence of major clinical events (death and pulmonary embolism) was ∼1% with wide confidence margins in even large non-inferiority studies. The incidence of asymptomatic VTE, especially distal, appears to be higher with aspirin. Patient preference and lower costs could play an important role in the choice in favour of aspirin.
摘要：
静脉血栓栓塞症（VTE）是住院期间和住院后可能出现的严重并发症，特别是在全身麻醉下手术后。特别危险的是主要的整形外科手术程序，例如选择性膝关节或髋关节置换以及髋部骨折的治疗。在这些患者中,目前的指南推荐(低或低-中度证据水平)阿司匹林作为抗凝治疗的可能替代药物,用于在使用抗凝药物后预防长期静脉血栓栓塞.一些随机试验和荟萃分析表明，当比较阿司匹林和抗凝剂时，VTE的风险没有显着差异。然而,必须考虑到,大多数建议是基于择期骨科手术,骨折后的试验排除了血栓形成风险高的患者.因此,在大型非劣效性研究中,主要临床事件(死亡和肺栓塞)的总发生率为~1%,且具有广泛的置信区间.无症状性VTE的发生率，尤其是远端,阿司匹林似乎更高。患者的偏好和较低的成本可能在选择阿司匹林方面发挥重要作用。
