The efficacy of aspirin compared to low molecular weight heparin as thromboprophylaxis after orthopedic surgery: A systematic review and meta-analysis.

Feng Chen, Jing Guo
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Abstract

Background: Aspirin has increasingly gained attention as a thromboprophylaxis agent for patients undergoing orthopedic surgery; however, the results of recent clinical trials remain controversial. Therefore, in this meta-analysis, we compared the safety and efficacy of aspirin with those of low molecular weight heparin (LMWH) for patients undergoing major orthopedic surgeries leading to significant immobility and necessitating anticoagulants to prevent thromboembolic events. Methods: PubMed, Web of Science, Scopus, and the Cochrane Library were systematically searched from the inception to April 20, 2024, to identify clinical trials and randomized controlled trials comparing the effect of aspirin and LMWH on deep vein thrombosis (DVT), pulmonary thromboembolism (PTE), venous thromboembolism (VTE), major bleeding, short-term postoperative mortality, and adherence to treatment. VTE included DVT and PE in this study. A random-effects model (DerSimonian-Laird) was employed to pool data. Results: In total, 8 randomized controlled trials with 23,540 participants were included in this study. Compared to LMWH, the use of aspirin was associated with a significantly increased risk of DVT (RR 1.56, 95% CI (1.30-1.86), I2 = 0.00%), whereas no significant changes were observed in drug adherence (RR 1.04, 95% CI (0.94-1.14), I2 = 94.02%) and risk of PTE (RR 1.18, 95% CI (0.64-2.15), I2 = 58.64%), VTE (RR 1.51, 95% CI (0.89-2.57), I2 = 24.69%), major bleeding (RR 0.96, 95% CI (0.88-1.04), I2 = 0.00%), and mortality (RR 1.07, 95% CI (0.89-1.29), I2 = 0.00%) after orthopedic surgery. Conclusion: Aspirin is generally as safe as LMWH for preventing thromboembolic events among patients undergoing orthopedic surgery; however, aspirin can increase the risk of DVT.

阿司匹林与低分子肝素在骨科术后预防血栓的疗效比较:一项系统综述和荟萃分析。
背景:阿司匹林作为骨科手术患者的血栓预防药物越来越受到关注;然而,最近的临床试验结果仍然存在争议。因此,在这项荟萃分析中,我们比较了阿司匹林和低分子肝素(LMWH)对接受重大骨科手术的患者的安全性和有效性,这些患者会导致严重的行动不便,需要抗凝剂来预防血栓栓塞事件。方法:系统检索PubMed、Web of Science、Scopus和Cochrane Library,检索自成立至2024年4月20日的临床试验和随机对照试验,比较阿司匹林和低分子肝素对深静脉血栓形成(DVT)、肺血栓栓塞(PTE)、静脉血栓栓塞(VTE)、大出血、术后短期死亡率和治疗依从性的影响。本研究的VTE包括DVT和PE。采用随机效应模型(dersimonan - laird)汇集数据。结果:本研究共纳入8项随机对照试验,受试者23540人。LMWH相比,使用阿司匹林与深静脉血栓形成的风险显著增加(相对危险度1.56,95%可信区间(1.30 - -1.86),I2 = 0.00%),而没有观察到药物依从性显著变化(相对危险度1.04,95%可信区间(0.94 - -1.14),I2 = 94.02%)和PTE的风险(相对危险度1.18,95%可信区间(0.64 - -2.15),I2 = 58.64%),静脉血栓栓塞(相对危险度1.51,95%可信区间(0.89 - -2.57),I2 = 24.69%),主要出血(相对危险度0.96,95%可信区间(0.88 - -1.04),I2 = 0.00%),和死亡率(相对危险度1.07,95%可信区间(0.89 - -1.29),I2 = 0.00%)后整形手术。结论:阿司匹林预防骨科手术患者血栓栓塞事件的安全性与低分子肝素相当;然而,阿司匹林会增加深静脉血栓的风险。
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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