高低剂量阿司匹林预防人工关节置换术后静脉血栓栓塞症有效性和安全性的Meta分析  

Efficacy and safety of high-dose and low-dose aspirin in preventing venous thromboembolism after total joint arthroplasty:a Meta-analysis

作　　者：储诚翰 穆文博 郭子玉 杨汝清 李旭东 曹力 CHU Cheng-han;MU Wen-bo;GUO Zi-yu;YANG Ru-qing;LI Xu-dong;CO Li(Department of Joint Surgery,First Affiliated Hospital of Xinjiang Medical University,Urumqi,830054,China)

机构地区：[1]新疆医科大学第一附属医院关节外科,乌鲁木齐830054 [2]新疆医科大学药学院,乌鲁木齐830054 [3]新疆地区高发疾病研究教育部重点实验室(新疆医科大学),新疆骨科疾病临床医学研究中心,乌鲁木齐830054

出　　处：《中国骨与关节杂志》2024年第6期461-470,共10页Chinese Journal of Bone and Joint

基　　金：新疆维吾尔自治区科技计划重大专项项目(2022A03011)。

摘　　要：目的通过Meta分析评价低剂量阿司匹林与高剂量阿司匹林在预防人工关节置换术后静脉血栓栓塞症(venous thromboembolism,VTE)的有效性与安全性。方法检索PubMed、Web of Science、万方数据库、中国知网全文数据库自建库以来至2023年4月有关低剂量阿司匹林与高剂量阿司匹林预防关节置换术后VTE的有效性及安全性的临床对照研究,筛选符合纳入标准的文献,使用数据提取表收集相关数据,采用RevMan 5.4软件行Meta分析。结果本Meta分析共纳入10篇文献,59106例,其中低剂量组(81 mg每日2次)22591例,高剂量组(325 mg每日2次)36515例。Meta分析结果示相较于高剂量组,低剂量组中的术后VTE发生率(OR=0.65,95%CI:0.48~0.88,P=0.006)、深静脉血栓(deep vein thrombosis,DVT)发生率(OR=0.61,95%CI:0.42~0.89,P=0.01)及感染率(OR=0.37,95%CI:0.21~0.66,P=0.0006)更低,差异有统计学意义。术后肺栓塞(pulmonary embolism,PE)发生率、出血事件发生率及病死率差异无统计学意义(P>0.05)。亚组分析结果提示在初次关节置换术中,低剂量组VTE发生风险(OR=0.68,95%CI:0.50~0.93,I2=0%,P=0.02)、DVT发生风险(OR=0.59,95%CI:0.40~0.87,I2=41%,P=0.007)及感染风险(OR=0.33,95%CI:0.17~0.63,I2=0%,P=0.0008)均低于高剂量组;在关节翻修术中,低剂量组术后各并发症发生风险均与高剂量组类似。结论与高剂量阿司匹林相比,低剂量阿司匹林可以有效减少关节置换术后VTE、DVT及感染的发生,但两种剂量在预防PE、出血事件及死亡方面无明显差异。低剂量阿司匹林的作用,在接受关节翻修术的患者中可能受到一定限制。Objective To evaluate the efficacy and safety of low-dose aspirin and high-dose aspirin in preventing venous thromboembolism after total joint arthroplasty.Methods We searched PubMed,Web of Science,Wanfang Database,and CNKI full-text database to collect clinical control studies on the efficacy and safety of low-dose aspirin and high-dose aspirin in preventing venous thromboembolism after total joint arthroplasty from the establishment of the database to April 2023 based on the inclusion and exclusion criteria.The data of the studies were analyzed by RevMan 5.4 software.Results The Meta-analysis included a total of 10 studies involving 59106 samples,including 22591 in the low-dose aspirin group(81 mg bid)and 36515 in the high-dose aspirin group(325 mg bid).Meta analysis showed that the incidence rate of postoperative VTE(OR=0.65,95%CI:0.48-0.88,P=0.006),DVT(OR=0.61,95%CI:0.42-0.89,P=0.01),and infection(OR=0.37,95%CI:0.21-0.66,P=0.0006)were lower in the low-dose aspirin group when compared to the high-dose aspirin group,with statistically significant differences.There was no statistically significant difference in the incidence rate of postoperative PE,bleeding events,and mortality(P>0.05).The results of subgroup analysis showed that in the primary arthroplasty,the risk of occurrence of postoperative VTE(OR=0.68,95%CI:0.50-0.93,I2=0%,P=0.02),DVT(OR=0.59,95%CI:0.40-0.87,I2=41%,P=0.007),and infection(OR=0.33,95%CI:0.17-0.63,I2=0%,P=0.0008)in the low-dose aspirin group were lower than those in the high-dose aspirin group.In revision arthroplasty,the risk of occurrence of postoperative complications in the low-dose aspirin group was similar with that in the high-dose aspirin group.Conclusions Compared with the high-dose aspirin,low-dose aspirin can significantly reduce the incidence rate of postoperative VTE,DVT,and infection after total joint arthroplasty.There are no significant differences in PE,bleeding events and mortality between the two groups.However,the efficacy of low-dose aspirin may be limited in patients o

关 键 词：静脉血栓栓塞 阿司匹林 剂量效应关系 药物 关节成形术 置换 

分 类 号：R687.4[医药卫生—骨科学]