中国药房2024，Vol.35Issue(2)：219-225,7.DOI:10.6039/j.issn.1001-0408.2024.02.17
阿司匹林对比其他抗凝剂预防骨科术后血栓栓塞有效性和安全性的Meta分析
Meta-analysis of efficacy and safety of aspirin versus other anticoagulants in the prevention of thromboembolism after orthopedic surgery
摘要
Abstract
OBJECTIVE To evaluate the clinical efficacy and safety of aspirin versus other anticoagulants in the prevention of thromboembolism after orthopedic surgery.METHODS Retrieved from PubMed,Embase,the Cochrane Library,CNKI,Wanfang data and VIP,randomized controlled trials(RCTs)and cohort studies about aspirin(trial group)versus other anticoagulants(control group)were collected during the inception and June 1st,2023.After literature screening,data extraction and quality evaluation,the meta-analysis was conducted by using RevMan 5.4 software.RESULTS A total of 22 studies were included,involving 9 RCTs and 13 cohort studies.RCT results showed that the incidences of deep vein thrombosis(DVT)[RR=1.81,95%CI(1.36,2.40),P＜0.000 1]and postoperative pulmonary embolism(PE)[RR=1.55,95%CI(1.01,2.40),P=0.05]in trial group were significantly higher than control group.There was no statistically significant difference in the incidences of postoperative massive bleeding,postoperative surgical site infection,all-cause death,or any bleeding after surgery between 2 groups.In the cohort study,the incidence of any bleeding in trial group was significantly lower than control group[RR=0.71,95%CI(0.64,0.79),P＜0.000 1],while the differences in other indicators were not statistically significant(P＞0.05).The results of subgroup analysis based on different anticoagulants showed that in RCT,the incidences of DVT and PE after surgery in patients using low-molecular-weight heparin(LMWH)were significantly lower than using aspirin(P＜0.05);in the cohort study,the incidences of DVT and PE after surgery were significantly lower in patients using direct oral anticoagulants(DOAC)than using aspirin(P＜0.05).There was no statistically significant difference in the incidence of major bleeding between patients using aspirin and using DOAC and LWMH(P＞0.05)in both RCT and cohort study.CONCLUSIONS Aspirin is equally safe as other anticoagulants for the prevention of thromboembolism after orthopedic surgery,but its efficacy may not be as good as other anticoagulants.After orthopedic surgery,other anticoagulants should be preferred to prevent venous thromboembolism,and aspirin should be carefully considered.关键词
骨科手术/阿司匹林/抗凝剂/血栓栓塞/疗效/安全性/Meta分析Key words
orthopedic surgery/aspirin/anticoagulants/thromboembolism/efficacy/safety/meta-analysis分类
医药卫生引用本文复制引用
王佩,魏萌,陶瑛瑛,赵宇蕾,王静,周强..阿司匹林对比其他抗凝剂预防骨科术后血栓栓塞有效性和安全性的Meta分析[J].中国药房,2024,35(2):219-225,7.基金项目
国家自然科学基金项目(No.82104303) （No.82104303）
