Efficacy and safety of commonly used thromboprophylaxis agents following hip and knee arthroplasty.

IF 4.9 1区医学 Q1 ORTHOPEDICS

Bone & Joint Journal Pub Date : 2024-09-01 DOI:10.1302/0301-620X.106B9.BJJ-2023-1252.R2

Tim Cheok, Alexander Beveridge, Morgan Berman, Martin Coia, Alexander Campbell, Tycus T S Tse, Job N Doornberg, Ruurd L Jaarsma

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引用次数: 0

Abstract

Aims: We investigated the efficacy and safety profile of commonly used venous thromboembolism (VTE) prophylaxis agents following hip and knee arthroplasty.

Methods: A systematic search of PubMed, Embase, Cochrane Library, Web of Science, and OrthoSearch was performed. Prophylaxis agents investigated were aspirin (< 325 mg and ≥ 325 mg daily), enoxaparin, dalteparin, fondaparinux, unfractionated heparin, warfarin, rivaroxaban, apixaban, and dabigatran. The primary efficacy outcome of interest was the risk of VTE, whereas the primary safety outcomes of interest were the risk of major bleeding events (MBE) and wound complications (WC). VTE was defined as the confirmed diagnosis of any deep vein thrombosis and/or pulmonary embolism. Network meta-analysis combining direct and indirect evidence was performed. Cluster rank analysis using the surface under cumulative ranking (SUCRA) was applied to compare each intervention group, weighing safety and efficacy outcomes.

Results: Of 86 studies eligible studies, cluster rank analysis showed that aspirin < 325 mg daily (SUCRA-VTE 89.3%; SUCRA-MBE 75.3%; SUCRA-WC 71.1%), enoxaparin (SUCRA-VTE 55.7%; SUCRA-MBE 49.8%; SUCRA-WC 45.2%), and dabigatran (SUCRA-VTE 44.9%; SUCRA-MBE 52.0%; SUCRA-WC 41.9%) have an overall satisfactory efficacy and safety profile.

Conclusion: We recommend the use of either aspirin < 325 mg daily, enoxaparin, or dabigatran for VTE prophylaxis following hip and knee arthroplasty.

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髋关节和膝关节置换术后常用血栓预防药物的有效性和安全性。

目的：我们研究了髋关节和膝关节置换术后常用静脉血栓栓塞（VTE）预防药物的疗效和安全性：对 PubMed、Embase、Cochrane Library、Web of Science 和 OrthoSearch 进行了系统检索。研究的预防药物包括阿司匹林（每日用量小于 325 毫克和大于 325 毫克）、依诺肝素、达肝素、磺达肝癸、非小分量肝素、华法林、利伐沙班、阿哌沙班和达比加群。主要疗效指标为 VTE 风险，主要安全性指标为大出血事件（MBE）和伤口并发症（WC）风险。VTE的定义是任何深静脉血栓和/或肺栓塞的确诊。结合直接和间接证据进行了网络荟萃分析。在权衡安全性和有效性结果的基础上，采用表面下累积排名（SUCRA）进行聚类排序分析，对各干预组进行比较：在 86 项符合条件的研究中，聚类排序分析表明，阿司匹林< 325 毫克/天（SUCRA-VTE 89.3%；SUCRA-MBE 75.3%；SUCRA-WC 71.1%）、依诺肝素（SUCRA-VTE 55.7%；SUCRA-MBE 49.8%；SUCRA-WC 45.2%）和达比加群（SUCRA-VTE 44.9%；SUCRA-MBE 52.0%；SUCRA-WC 41.9%）的疗效和安全性总体令人满意：我们建议在髋关节和膝关节置换术后使用阿司匹林< 325 mg/天、依诺肝素或达比加群来预防 VTE。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Bone & Joint Journal ORTHOPEDICS-SURGERY

CiteScore

9.40

自引率

10.90%

发文量

318

期刊介绍： We welcome original articles from any part of the world. The papers are assessed by members of the Editorial Board and our international panel of expert reviewers, then either accepted for publication or rejected by the Editor. We receive over 2000 submissions each year and accept about 250 for publication, many after revisions recommended by the reviewers, editors or statistical advisers. A decision usually takes between six and eight weeks. Each paper is assessed by two reviewers with a special interest in the subject covered by the paper, and also by members of the editorial team. Controversial papers will be discussed at a full meeting of the Editorial Board. Publication is between four and six months after acceptance.