持续服用阿司匹林和氯吡格雷对初级选择性全膝关节和髋关节置换术围手术期结局的影响：一项系统回顾和荟萃分析

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2025-07-24 DOI:10.1016/j.jor.2025.07.024

M.M. Farhan-Alanie , A. Abdul-Hussein , A. Stephens , M. Blankstein

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引用次数: 0

摘要

大约20%的原发性选择性全髋关节置换术（THR）或膝关节置换术（TKR）患者服用抗血小板药物。两种主要的管理策略是术前继续或停止抗血小板药物治疗。持续使用抗血小板药物可能会增加出血、伤口并发症和感染的风险。停用抗血小板药物可能增加心脑血管不良事件的风险。本系统综述和荟萃分析评估了持续服用阿司匹林或氯吡格雷对THR或TKR患者围手术期预后的影响。方法检索medline、Embase、Web of Science和Cochrane Library，检索报告结果的随机对照试验和队列研究，包括失血、感染、伤口并发症、手术时间、住院时间、静脉血栓栓塞、心脑血管事件、死亡率等。进行随机效应荟萃分析。结果8项研究纳入了928例thr和3526例tkr的数据。持续抗血小板治疗对THR （MD -16.57 ml, 95% CI -120.75 ~ 87.61, p = 0.76）或TKR （MD -0.06 ml, 95% CI -6.04 ~ 5.91, p = 0.98）术中出血量无影响。然而，TKR患者继续抗血小板治疗有更高的输血风险（OR 1.63, 95% CI 1.25-2.13, p = 0.0003），尽管THR患者没有观察到差异（OR 1.71, 95% CI 0.84-3.49, p = 0.14）。在THR和TKR患者组之间，感染、心脑血管事件和术后死亡率没有显著差异。结论TKR期间持续抗血小板使用与输血风险增加相关，而非THR。手术并发症和医疗不良事件不受抗血小板药物使用的影响。需要更大样本量的进一步研究才能得出明确的结论。普洛斯彼罗(CRD42024470601)

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The effects of continuing aspirin and clopidogrel on perioperative outcomes in primary elective total knee and hip replacement: A systematic review and meta-analysis

Introduction

Approximately 20 % of patients undergoing primary elective total hip (THR) or knee replacement (TKR) take an antiplatelet medication. The two main management strategies are continuing or discontinuing the antiplatelet medication pre-operatively. Continuing antiplatelets may increase the risk of bleeding, wound complications, and infection. Discontinuing antiplatelets may increase the risk of cardiac and cerebrovascular adverse events. This systematic review and meta-analysis evaluated the effects of continuing aspirin or clopidogrel on the perioperative outcomes of patients undergoing THR or TKR.

Methods

Medline, Embase, Web of Science, and Cochrane Library were searched for randomised controlled trials and cohort studies reporting on outcomes blood loss, infection, wound complications, operative duration, length of stay, venous thromboembolism, cardiac and cerebrovascular events, mortality, and others. Random effects meta-analysis was performed.

Results

Eight studies enabled inclusion of data on 928 THRs and 3526 TKRs. Continuing antiplatelet therapy did not affect intraoperative blood loss in THR (MD -16.57 ml, 95 % CI -120.75–87.61, p = 0.76) or TKR (MD -0.06 ml, 95 %CI -6.04–5.91, p = 0.98). However, TKR patients continuing antiplatelet therapy had a higher risk of blood transfusion (OR 1.63, 95 %CI 1.25–2.13, p = 0.0003) although there were no differences observed in THR patients (OR 1.71, 95 %CI 0.84–3.49, p = 0.14). No significant differences were found for outcomes infection, cardiac and cerebrovascular events, and post-operative mortality between patient groups following THR and TKR.

Conclusions

Continuing antiplatelet use during TKR, but not THR, was associated with an increased risk of blood transfusion. Surgical complications and medical adverse events were not influenced by antiplatelet use. Further research with larger sample sizes is needed to draw definitive conclusions.

PROSPERO (CRD42024470601)

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.