阿司匹林对比其他抗凝剂预防骨科术后血栓栓塞有效性和安全性的Meta分析

王佩; 魏萌; 陶瑛瑛; 赵宇蕾; 王静; 周强

doi:10.6039/j.issn.1001-0408.2024.02.17

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阿司匹林对比其他抗凝剂预防骨科术后血栓栓塞有效性和安全性的Meta分析

循证药学 | 更新时间：2024-01-24

- 阿司匹林对比其他抗凝剂预防骨科术后血栓栓塞有效性和安全性的Meta分析
- Meta-analysis of efficacy and safety of aspirin versus other anticoagulants in the prevention of thromboembolism after orthopedic surgery
- 中国药房 2024年35卷第2期页码：219-225
- 作者机构：
  
  1.东部战区总医院药剂科，南京　210002
  2.东部战区总医院临床药学科，南京　210002
  3.东部战区总医院心血管内科，南京　210002
- 作者简介：
  
  主管护师。研究方向：循证护理。E-mail：895077482@qq.com
  主管药师，硕士。研究方向：循证药学、心血管药学。E-mail：1196008514@qq.com
- 基金信息：
  
  国家自然科学基金项目(82104303)
- DOI：10.6039/j.issn.1001-0408.2024.02.17
  中图分类号： R973+.2
- 纸质出版日期：2024-01-30，
  
  收稿日期：2023-08-03，
  
  修回日期：2023-12-07，
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王佩,魏萌,陶瑛瑛等.阿司匹林对比其他抗凝剂预防骨科术后血栓栓塞有效性和安全性的Meta分析 ^Δ[J].中国药房,2024,35(02):219-225.

WANG Pei,WEI Meng,TAO Yingying,et al.Meta-analysis of efficacy and safety of aspirin versus other anticoagulants in the prevention of thromboembolism after orthopedic surgery[J].ZHONGGUO YAOFANG,2024,35(02):219-225.
王佩,魏萌,陶瑛瑛等.阿司匹林对比其他抗凝剂预防骨科术后血栓栓塞有效性和安全性的Meta分析 ^Δ[J].中国药房,2024,35(02):219-225. DOI： 10.6039/j.issn.1001-0408.2024.02.17.

WANG Pei,WEI Meng,TAO Yingying,et al.Meta-analysis of efficacy and safety of aspirin versus other anticoagulants in the prevention of thromboembolism after orthopedic surgery[J].ZHONGGUO YAOFANG,2024,35(02):219-225. DOI： 10.6039/j.issn.1001-0408.2024.02.17.

摘要

目的

评价阿司匹林对比其他抗凝剂预防骨科术后血栓栓塞的疗效和安全性。

方法

检索PubMed、Embase、the Cochrane Library、中国知网、万方数据和维普网，收集阿司匹林（试验组）对比其他抗凝剂（对照组）的随机对照试验（RCT）和队列研究。检索时限为建库起至2023年6月1日。筛选文献，提取资料及质量评价后，采用RevMan 5.4软件进行Meta分析。

结果

共纳入22项研究，9篇为RCT，13篇为队列研究。RCT中，试验组患者术后深静脉血栓（DVT）发生率[RR＝1.81，95%CI（1.36，2.40），

＜0.000 1]、术后肺栓塞（PE）发生率[RR＝1.55，95%CI（1.01，2.40），

＝0.05]均显著高于对照组；两组患者术后大出血发生率、术后手术部位感染发生率、全因死亡率、术后任何出血发生率比较，差异均无统计学意义。队列研究中，试验组患者术后任何出血发生率显著低于对照组[RR＝0.71，95%CI（0.64，0.79），

＜0.000 1]，其余指标比较差异均无统计学意义（

＞0.05）。按其他抗凝剂不同进行的亚组分析结果显示，RCT中，使用低分子肝素（LMWH）患者术后DVT发生率和术后PE发生率均显著低于使用阿司匹林患者（

＜0.05）；队列研究中，使用直接口服抗凝药（DOAC）患者术后DVT发生率和术后PE发生率均显著低于使用阿司匹林患者（

＜0.05）；无论在RCT还是队列研究中，使用阿司匹林患者与使用DOAC、LWMH患者的术后大出血发生率比较，差异均无统计学意义（

＞0.05）。

结论

阿司匹林与其他抗凝剂预防骨科术后血栓栓塞的安全性相当，但疗效可能不及其他抗凝剂。骨科术后应优选其他抗凝剂预防静脉血栓栓塞，需谨慎考虑阿司匹林。

Abstract

OBJECTIVE

To evaluate the clinical efficacy and safety of aspirin versus other anticoagulants in the prevention of thromboembolism after orthopedic surgery.

METHODS

Retrieved from PubMed， Embase， the Cochrane Library， CNKI， Wanfang data and VIP， randomized controlled trials （RCTs） and cohort studies about aspirin （trial group） versus other anticoagulants （control group） were collected during the inception and June 1st， 2023. After literature screening， data extraction and quality evaluation， the meta-analysis was conducted by using RevMan 5.4 software.

RESULTS

A total of 22 studies were included， involving 9 RCTs and 13 cohort studies. RCT results showed that the incidences of deep vein thrombosis （DVT） [RR＝1.81， 95%CI（1.36， 2.40），

＜0.000 1] and postoperative pulmonary embolism （PE） [RR＝1.55， 95%CI（1.01， 2.40），

＝0.05] in trial group were significantly

higher than control group. There was no statistically significant difference in the incidences of postoperative massive bleeding， postoperative surgical site infection， all-cause death， or any bleeding after surgery between 2 groups. In the cohort study， the incidence of any bleeding in trial group was significantly lower than control group [RR＝0.71， 95%CI （0.64， 0.79），

＜0.000 1]， while the differences in other indicators were not statistically significant （

＞0.05）. The results of subgroup analysis based on different anticoagulants showed that in RCT， the incidences of DVT and PE after surgery in patients using low-molecular-weight heparin （LMWH） were significantly lower than using aspirin （

＜0.05）； in the cohort study， the incidences of DVT and PE after surgery were significantly lower in patients using direct oral anticoagulants （DOAC） than using aspirin （

＜0.05）. There was no statistically significant difference in the incidence of major bleeding between patients using aspirin and using DOAC and LWMH （

＞0.05） in both RCT and cohort study.

CONCLUSIONS

Aspirin is equally safe as other anticoagulants for the prevention of thromboembolism after orthopedic surgery， but its efficacy may not be as good as other anticoagulants. After orthopedic surgery， other anticoagulants should be preferred to prevent venous thromboembolism， and aspirin should be carefully considered.

关键词

骨科手术阿司匹林抗凝剂血栓栓塞疗效安全性Meta分析

Keywords

aspirinanticoagulantsthromboembolismefficacysafetymeta-analysis

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