背景:静脉血栓栓塞症(VTE)是骨科大手术后最常见的并发症之一。最近的研究表明,阿司匹林也可能有效预防VTE。但是它是否可以常规使用仍然存在争议。目的:比较阿司匹林对口服抗凝剂预防全髋关节置换术(THA)后VTE的疗效和安全性。全膝关节置换术(TKA)或髋部骨折手术(HFS)。方法:使用PubMed等电子搜索数据库获得相关出版物,Embase,WebofScience,科克伦图书馆,和临床试验。政府。从成立到2023年7月20日。荟萃分析仅包括评估阿司匹林与接受大型骨科手术的口服抗凝剂相比的有效性和安全性的RCT。报告的主要结果是任何VTE事件(包括深静脉血栓形成(DVT)和肺栓塞(PE))。次要结果包括死亡率,大出血(包括胃肠道出血,脑血管出血,或任何需要返回剧院的出血),轻微出血(瘀斑,鼻出血,血尿),伤口并发症。根据CochraneCollaboration的工具评估所有纳入研究的偏倚风险。结果:在筛选974项研究后,包括12项随机临床试验(RCT),涉及5088名参与者,包括2540名阿司匹林参与者,2,205名利伐沙班参与者,和华法林的323名参与者。在骨科大手术后的血栓预防中,阿司匹林的有效性低于口服抗凝剂(RR=1.206,95%CI1.053-1.383)。根据口服抗凝剂的类型进行亚组分析后,结果显示,阿司匹林与利伐沙班相似,低于华法林。考虑到华法林组的研究都是在2000年之前进行的,我们的结果需要进一步证实。此外,阿司匹林组比其他亚组的对照组有更高的VTE风险,包括≤3个月的随访时间,手术类型为TKA,大剂量阿司匹林(≥650mgqd),并且没有联合使用机械预防。在安全事件方面,阿司匹林在大出血中没有显着差异(RR=0.952,95%CI0.499-1.815),全因死亡率(RR=1.208,95%CI0.459-3.177),与口服抗凝药相比,伤口相关事件(RR=0.618,95%CI0.333-1.145),阿司匹林与轻微出血事件(RR=0.685,95%CI0.552-0.850)和总出血(RR=0.726,95%CI0.590-0.892)的风险降低相关.结论:与口服抗凝药相比,阿司匹林可降低骨科大手术后出血风险。但可能在一定程度上牺牲VTE的预防。需要更新的证据来分析阿司匹林对骨科大手术患者的血栓预防作用。系统审查注册:https://www。crd.约克。AC.uk/prospro/display_record.php?RecordID=463481,标识符CRD42023463481。
Background: venous thromboembolism (VTE) is one of the most common complications after major orthopaedic surgery. Recent studies have suggested that aspirin may also be effective in preventing VTE, but it is still controversial whether it can be routinely used. Objectives: To compare the efficacy and safety of aspirin against oral anticoagulants in the prevention of VTE following total hip arthroplasty (THA), total knee arthroplasty (TKA) or hip fracture surgery (HFS). Methods: Relevant publications have been obtained using electronic search databases such as PubMed, Embase, Web of Science, Cochrane Library, and Clinical Trials. gov. from inception to 20 July 2023. Only RCTs evaluating the efficacy and safety of aspirin compared with oral anticoagulants undergoing major orthopaedic surgery were included in the meta-analysis. The primary outcome reported was any VTE event (including deep vein thrombosis (DVT) and pulmonary embolism (PE)). Secondary outcomes included mortality, major bleeding (including gastrointestinal bleed, cerebrovascular hemorrhage, or any bleeding requiring a return to the theater), minor bleeding (ecchymosis, epistaxis, hematuria), and wound complications. The risk of bias for all included studies was assessed according to the Cochrane Collaboration\'s tool. Results: After screening 974 studies, 12 randomized clinical trials (RCTs) were included, involving 5,088 participants, including 2,540 participants in aspirin, 2,205 participants in rivaroxaban, and 323 participants in warfarin. Aspirin was found to be less effective than oral anticoagulants in thromboprophylaxis after major orthopedic surgery (RR = 1.206, 95% CI 1.053-1.383). After subgroup analysis according to the type of oral anticoagulant, the results showed that aspirin was similar to rivaroxaban and inferior to warfarin. Considering that the studies in the warfarin group were all conducted before 2000, our results need to be further confirmed. In addition, the aspirin group had a higher risk of VTE than the control group in other subgroups, including a follow-up time of ≤3 months, type of procedure as TKA, high-dose aspirin (≥650 mg qd), and no combined use of mechanical prophylaxis. In terms of safety events, aspirin did not show significant differences in major bleeding (RR = 0.952, 95% CI 0.499-1.815), all-cause mortality (RR = 1.208, 95% CI 0.459-3.177), and wound-related events (RR = 0.618, 95% CI 0.333-1.145) compared with oral anticoagulants, and aspirin was associated with a reduction in the risk of minor bleeding (RR = 0.685, 95% CI 0.552-0.850) events and total bleeding (RR = 0.726, 95% CI 0.590-0.892). Conclusion: Aspirin reduces bleeding risk after major orthopedic surgery compared with oral anticoagulants, but may sacrifice VTE prevention to some extent. Updated evidence is needed to analyze the thromboprophylaxis effects of aspirin in patients undergoing major orthopedic surgery. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=463481, identifier CRD42023463481.