目的:激素替代疗法(HRT),绝经期激素治疗(MHT),含雌激素的药物经常在选择性下肢关节置换术前被停用,基于静脉血栓栓塞(VTE)的感知风险。然而,HRT之间联系的证据,MHT,增加的VTE风险是模棱两可的。本系统评价评估了国际临床实践指南(CPGs)在拒绝HRT或MHT方面的一致性。
方法:PubMed,谷歌学者,科克伦,并在Ovid数据库中搜索了预CPG,接受选择性下肢关节置换术的HRT和MHT患者的围手术期和术后管理。然后通过对互联网的搜索进行补充。有七个英语国际CPG,来自欧洲和北美,在2000年1月至2023年2月期间发布,根据《研究与评估工具评估指南》(AGREE-II)标准进行了审查,根据系统审查和荟萃分析(PRISMA)清单的首选报告项目。
结果:所审查的指南揭示了HRT或MHT在关节成形术中的戒断和使用的混合情况,一些关于HRT或MHT(苏格兰校际指南网络)的术前和术后管理的详细建议,而其他人则没有指导(美国胸科医师学院)。回顾这些指南中引用的证据,突出显示HRT或MHT在增加VTE风险方面发挥有限的作用。大多数研究来自1990年代和2000年代。
结论:根据目前的证据,不含雌激素的经皮HRT或MHT不应该在接受选择性关节置换术的患者中保留,尽管需要进一步的证据来证明扣留含雌激素的形式是合理的。
BACKGROUND: Hormone replacement therapy (HRT), menopausal hormone therapy (MHT), and estrogen-containing medications are frequently withheld before elective lower limb arthroplasty, based on a perceived risk of venous thromboembolism (VTE). However, evidence linking HRT, MHT, and an increased VTE risk is equivocal. This systematic review evaluated the concordance of international clinical practice
guidelines (CPGs) on the withholding of HRT or MHT.
METHODS: The PubMed, Google Scholar, Cochrane, and Ovid databases were searched for CPGs for the preoperative, perioperative, and postoperative management of patients on HRT and MHT undergoing elective lower limb arthroplasty. This was supplemented by an internet search. There were 7 international CPGs in English, from Europe and North America, published between January 2000 and February 2023 reviewed against the Appraisal of
Guidelines for Research & Evaluation Instrument (AGREE-II) criteria, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.
RESULTS: The
guidelines reviewed revealed a mixed picture on HRT or MHT withdrawal and use in arthroplasty, with some featuring detailed advice on the preoperative and postoperative management of HRT or MHT (Scottish Intercollegiate
Guidelines Network), while others featured no guidance (American College of Chest Physicians). The evidence referenced in these
guidelines highlighted studies showing HRT or MHT to play a limited role in increasing VTE risk, with most studies from the 1990s and 2000s.
CONCLUSIONS: Based on current evidence, non-estrogen-containing transdermal HRT or MHT should not be withheld in patients undergoing elective joint arthroplasty, though further evidence is required to justify withholding estrogen-containing forms.