背景:静脉血栓栓塞症(VTE)是髋关节或膝关节置换术后公认的并发症,可导致严重的发病率和死亡率。虽然抗凝剂是化学预防的主要手段,阿司匹林最近成为一种流行的预防剂。然而,缺乏将阿司匹林与抗凝剂作为预防VTE的方法进行比较的高质量证据,目前的指南在使用阿司匹林作为一线化疗预防方面存在矛盾.我们旨在研究与阿司匹林作为一线药物的推荐或反对相关的指南特征。
方法:MedLine,EMBASE,CINAHL,从1966年至2024年1月检索了PubMed数据库,以确定平均风险的成人髋关节或膝关节置换术住院患者VTE预防的临床实践指南.该指南的特征由两名独立审阅者收集。使用Logistic回归检验阿司匹林的推荐或反对与指南特征之间的关联。
结果:从2003年2月到2023年9月,有26个指南发表并包括在本研究中。有5个指南推荐阿司匹林和11个指南推荐阿司匹林作为一线治疗。随着最近一年的出版,阿司匹林更有可能被推荐(比值比(OR)1.72,95%置信区间(CI):1.05~2.84),而不太可能被推荐(OR0.61,95%CI:0.41~0.90).没有其他变量,包括使用的证据水平,准则工作组的组成,或指南的目标与阿司匹林的推荐或反对相关.
结论:指南关于阿司匹林作为关节置换患者VTE预防一线治疗的建议不一致。使用现代实践的足够有力的随机对照试验(RCT),例如术后早期动员,需要更好地告知临床实践指南。
BACKGROUND: Venous thromboembolism (VTE) is a recognized postoperative complication of hip or knee arthroplasty and incurs major morbidity and mortality. While anticoagulants are the mainstay of chemoprophylaxis, aspirin has recently emerged as a popular prophylactic agent. However, there is a lack of high-quality evidence comparing aspirin to anticoagulants as a method of VTE prophylaxis, and current guidelines are conflicting regarding using aspirin as first-line chemoprophylaxis. We aimed to investigate
guideline characteristics that are associated with the recommendation for or against aspirin as a first-line agent.
METHODS: MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, and PubMed databases were searched from 1966 to January 2024 to identify clinical practice guidelines for VTE prophylaxis in adult hip or knee arthroplasty inpatients of average risk. The characteristics of the
guideline were collected by 2 independent reviewers. Logistic regression was used to test the association between the recommendation for or against aspirin and guideline characteristics.
RESULTS: There were 26 guidelines published from February 2003 to September 2023 and included in this study. There were 5
guidelines that recommended aspirin and 11
guidelines that recommended against aspirin as first-line therapy. With a more recent year of publication, aspirin was more likely to be recommended (odds ratio 1.72, 95% confidence interval: 1.05 to 2.84) and less likely to be recommended against (odds ratio 0.61, 95% confidence interval: 0.41 to 0.90). No other variables, including the level of evidence used, the composition of the
guideline working group, or the objective of the
guideline, were associated with the recommendation for or against aspirin.
CONCLUSIONS: Guidelines were inconsistent in their recommendations regarding aspirin as first-line therapy as VTE prophylaxis in arthroplasty patients. Adequately powered randomized controlled trials using modern practices, such as early postoperative mobilization, are needed to better inform clinical practice guidelines.