阿司匹林在关节置换术后预防静脉血栓形成中的有效性及安全性meta分析

Efficacy and Safety of Aspirin in Preventing Venous Thrombosis after Joint Replacement: A Meta-Analysis

摘要: 目的：系统评价阿司匹林与临床常用抗凝药物在全髋关节置换术(THA)和全膝关节置换术(TKA)后预防静脉血栓形成中的有效性及安全性。方法：通过检索建库至2022年5月间PubMed，MEDLINE，Embase，Web of Science, Cochrane Library databases，中国知网、万方、维普等数据库中比较阿司匹林与临床常用抗凝药物在全髋关节置换术和全膝关节置换术后预防静脉血栓形成中的有效性及安全性的随机对照试验。严格按照纳入及排除标准进行研究筛选，并使用Cochrane偏倚风险评估工具评价随机对照试验偏倚风险，进行纳入文献的资料提取整理，采用Review Manager 5.4.1软件进行meta分析，对比术后深静脉血栓发生率、术后肺栓塞发生率、出血事件发生率、伤口并发症发生率、胃肠道不良反应发生率、围术期总出血量等指标结果共纳入9项符合纳入标准的随机对照试验，纳入的研究共包括5591例患者，阿司匹林组2775例和对照组2816例，对照组包括利伐沙班组1813例，低分子肝素组867例，华法林组146例，低分子右旋糖酐组50例。全膝关节置换术组一共纳入2830例患者，全髋关节置换术组一共纳入2761例患者。meta分析结果显示：阿司匹林组和对照组在深静脉血栓发生率未见明显统计学差异(RR: 0.90, 95% CI: 0.63~1.29, P = 0.57)；阿司匹林组和对照组在肺栓塞发生率未见明显统计学差异(RR: 0.91, 95% CI: 0.53~1.56, P= 0.72)；阿司匹林组和对照组在出血事件发生率、伤口并发症发生率、胃肠道不良反应发生率及围术期总出血量等方面均未见明显统计学差异；根据研究地区、手术类型、是否使用物理预防血栓、血栓诊断方法及比较的药物类型等方面进行亚组分析，结果提示均未见明显统计学差异。结论：阿司匹林不仅在全髋关节置换术及全膝关节置换术术后抗凝效果方面并不差于其他常见的低分子肝素、利伐沙班等抗凝药物，而且在术后出血事件发生率、伤口并发症发生率、围术期总出血量等方面也与其他常见抗凝药物相同。

Abstract: Objective: To systematically evaluate the efficacy and safety of aspirin and other anticoagulants in the prevention of venous thrombosis after total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods: A Meta analysis was conducted to compare the efficacy and safety of aspirin and other anticoagulants in the prevention of venous thrombosis after total hip arthroplasty and total knee arthroplasty by searching randomized controlled trials in PubMed, MEDLINE, EMBASE, web of science, Cochrane library databases, CNKI, Wanfang, VIP and other databases from the establishment of the database to May 2022. The study was screened strictly according to the inclusion and exclusion criteria and used the Cochrane bias risk assessment tool to assess the bias risk in ran-domized controlled trials. The data included in the literature were extracted and sorted out. The Review Manager 5.4.1 software was used for meta-analysis to compare the incidence of postopera-tive deep vein thrombosis, postoperative pulmonary embolism, bleeding events, wound complications, gastrointestinal adverse reactions Perioperative total bleeding volume and other indicators. Results include nine randomized controlled trials that meet the criteria for inclusion. The included studies included 5591 patients, 2775 in the aspirin group and 2816 in the control group. The con-trol group included 1813 in the rivaroxaban group, 867 in the low molecular weight heparin group, 146 in the warfarin group and 50 in the low molecular weight dextran group. There were 2830 pa-tients in the Total knee arthroplasty (TKA) group and 2761 patients in the total hip arthroplasty (THA) group. The results of meta-analysis showed that there was no significant difference in the in-cidence of deep venous thrombosis between aspirin group and control group (RR: 0.90, 95% CI: 0.63~1.29, P= 0.57); There was no significant difference in the incidence of pulmonary embolism between aspirin group and control group (RR: 0.91, 95% CI: 0.53~1.56, P= 0.72); There was no sig-nificant difference between aspirin group and control group in the incidence of bleeding events, wound complications, gastrointestinal adverse reactions and total perioperative bleeding; Sub-group analysis was conducted according to the study area, type of operation, whether to use physi-cal prevention of thrombus, thrombus diagnosis methods and the types of drugs compared. The results showed that there was no significant statistical difference between these characteristics. Con-clusion: Aspirin is not only not inferior to other common anticoagulant drugs such as low molecular weight heparin and rivaroxaban in the anticoagulation effect after total hip arthroplasty and total knee arthroplasty, but also the same as other common anticoagulant drugs in the incidence of postoperative bleeding events, the incidence of wound complications and the total amount of peri-operative bleeding.