Aspirin Is as Effective and Safe as Oral Anticoagulants for Venous Thromboembolism Prophylaxis After Joint Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

IF 4.4 1区医学 Q1 ORTHOPEDICS

Journal of Bone and Joint Surgery, American Volume Pub Date : 2025-01-21 DOI:10.2106/JBJS.24.00946

Zhenghua Hong, Yongwei Su, Liwei Zhang, Hua Luo

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引用次数: 0

Abstract

Background: Joint arthroplasty effectively treats osteoarthritis, providing pain relief and improving function, but postoperative venous thromboembolism (VTE) remains a common complication. This study therefore assessed the effectiveness and safety of aspirin compared with oral anticoagulants (OACs) for VTE prophylaxis after joint arthroplasty.

Methods: A systematic review and meta-analysis was performed by searching PubMed, Embase, the Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) up to May 14, 2024, that compared the effect of aspirin versus OACs on VTE prophylaxis in adults undergoing joint arthroplasty. Data extraction followed the PRISMA guidelines. Two independent researchers conducted the literature searches and data extraction. A random-effects model was used to estimate effects. The primary outcome was the incidence of VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE); secondary outcomes included bleeding, wound complications, and mortality.

Results: The meta-analysis included 11 RCTs with a total of 4,717 participants (55.1% female) from several continents. The relative risk (RR) of VTE following joint arthroplasty was 1.11 (95% confidence interval [CI], 0.93 to 1.32) for aspirin compared with OACs. Similar results were observed for DVT (RR, 1.12; 95% CI, 0.90 to 1.40) and PE (RR, 1.18; 95% CI, 0.51 to 2.71). There were no significant differences in the risks of bleeding, wound complications, or mortality between patients receiving aspirin and those receiving OACs. Subgroup analyses considering factors such as study region, type of joint surgery, type of VTE detection, year of publication, use of mechanical VTE prophylaxis, aspirin dose, type of OAC comparator, study quality, and funding also found no significant differences in VTE incidence between aspirin and OACs. The overall quality of evidence for VTE and DVT outcomes was high.

Conclusions: Based on high-quality evidence from RCTs, aspirin is as effective and safe as OACs in preventing VTE, including DVT and PE, after joint arthroplasty, without increasing complications.

Level of evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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阿司匹林与口服抗凝剂在关节置换术后预防静脉血栓栓塞一样有效和安全：随机临床试验的系统回顾和荟萃分析

背景：关节置换术能有效治疗骨关节炎，缓解疼痛并改善功能，但术后静脉血栓栓塞（VTE）仍然是常见的并发症。因此，本研究评估了阿司匹林与口服抗凝剂（OACs）在关节置换术后静脉血栓栓塞预防中的有效性和安全性。方法：通过检索PubMed、Embase、Web of Science和Cochrane Library，对截至2024年5月14日的随机对照试验（rct）进行系统回顾和荟萃分析，比较阿司匹林和OACs对成人关节置换术中静脉血栓栓塞预防的影响。数据提取遵循PRISMA指南。两位独立研究人员进行了文献检索和数据提取。采用随机效应模型估计效果。主要终点是静脉血栓形成（VTE）的发生率，包括深静脉血栓形成（DVT）和肺栓塞（PE）；次要结局包括出血、伤口并发症和死亡率。结果：荟萃分析包括11项随机对照试验，共有4,717名参与者（55.1%为女性）来自几个大洲。与OACs相比，阿司匹林关节置换术后静脉血栓栓塞的相对危险度（RR）为1.11（95%可信区间[CI]， 0.93 ~ 1.32）。深静脉血栓形成的结果相似(RR, 1.12；95% CI, 0.90 ~ 1.40)和PE (RR, 1.18；95% CI, 0.51 ~ 2.71)。服用阿司匹林的患者和服用OACs的患者在出血、伤口并发症或死亡率方面没有显著差异。考虑研究区域、关节手术类型、静脉血栓栓塞检测类型、发表年份、机械静脉血栓栓塞预防的使用、阿司匹林剂量、OAC比较剂类型、研究质量和资金等因素的亚组分析也发现阿司匹林和OAC之间的静脉血栓栓塞发生率无显著差异。VTE和DVT结果的总体证据质量很高。结论：基于随机对照试验的高质量证据，阿司匹林在预防关节置换术后静脉血栓栓塞（包括DVT和PE）方面与OACs一样有效和安全，且不会增加并发症。证据水平：治疗性i级。参见《作者说明》获得证据水平的完整描述。

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来源期刊

Journal of Bone and Joint Surgery, American Volume 医学-外科

CiteScore

8.90

自引率

7.50%

发文量

660

审稿时长

1 months

期刊介绍： The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.