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中华关节外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (03) : 340 -347. doi: 10.3877/cma.j.issn.1674-134X.2023.03.007

荟萃分析

抗凝剂预防膝关节镜术后血栓发生的Meta分析
张程, 何海军(), 张光熠, 熊冰朗, 田天照, 孙诗艺, 吴子轩   
  1. 100102 北京,中国中医科学院望京医院
    100102 北京中医药大学
    510145 广州医科大学附属中医医院
  • 收稿日期:2022-11-23 出版日期:2023-06-01
  • 通信作者: 何海军
  • 基金资助:
    国家自然科学基金项目(81873322); 北京市自然科学基金项目(7222298)

Meta-analysis anticoagulant prevention of thrombosis after knee arthroscopy

Cheng Zhang, Haijun He(), Guangyi Zhang, Binglang Xiong, Tianzhao Tian, Shiyi Sun, Zixuan Wu   

  1. Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China
    Beijing University of Chinese Medicine, Beijing 100102, China
    Hospital of Traditional Chinese Medicine Affiliated to Guangzhou Medical University, Guangzhou 510145, China
  • Received:2022-11-23 Published:2023-06-01
  • Corresponding author: Haijun He
引用本文:

张程, 何海军, 张光熠, 熊冰朗, 田天照, 孙诗艺, 吴子轩. 抗凝剂预防膝关节镜术后血栓发生的Meta分析[J/OL]. 中华关节外科杂志(电子版), 2023, 17(03): 340-347.

Cheng Zhang, Haijun He, Guangyi Zhang, Binglang Xiong, Tianzhao Tian, Shiyi Sun, Zixuan Wu. Meta-analysis anticoagulant prevention of thrombosis after knee arthroscopy[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(03): 340-347.

目的

评价膝关节镜术后是否运用抗凝剂对下肢静脉血栓栓塞症(VTE)的预防效果。

方法

计算机检索PubMed、荷兰医学文摘(EMbase)、循证医学图书馆(Cochrane Library)、中国知网、万方等5个数据库,检索建库至2022年9月所有对比膝关节镜术后是否预防性使用抗凝药物的随机对照试验(RCTs),排除对照组使用抗凝药物,或试验组使用非药物抗凝的相关试验,由两名研究者独立筛选文献,对纳入的文献进行质量评价和数据提取,并选取肺栓塞(PE)发生率、有症状DVT发生率、下肢无症状近端DVT发生率作为疗效观察指标,严重出血率、轻微出血率作为安全性观察指标。采用RevMan 5.4软件进行Meta分析。

结果

最终纳入8篇文献,均为RCT,共4 302例患者。膝关节镜术后预防性抗凝组与不抗凝组PE发生率差异无统计学意义[相对危险度(RR)=1.36,95%置信区间(CI)(0.37,4.97),P=0.64];预防性抗凝组术后症状性DVT发生率低于不抗凝组[RR=0.32,95%CI(0.16,0.63),P=0.001];预防性抗凝组下肢无症状近端DVT发生率低于不抗凝组[RR=0.17,95%CI(0.06,0.48),P=0.0007];两组间严重出血发生率差异无统计学意义[RR=1.44,95%CI(0.25,8.14),P=0.68];预防性抗凝组轻微出血发生率高于不抗凝组,差异具有统计学意义[RR=1.47,95%CI(1.11,1.94),P=0.006]。

结论

膝关节镜术后预防性使用抗凝剂可有效降低症状性DVT和无症状近端DVT的发生率,且不会增加严重出血的风险。但无论是否抗凝,膝关节镜术后PE、症状性DVT、无症状近端DVT的发生率均较低,临床医生在抉择是否抗凝时应充分考虑患者的危险因素。

Objective

To evaluate the preventive effect of anticoagulant on venous thromboembolism after knee arthroscopy.

Methods

Five databases including PubMed, Excerpta Medica Database(EMbase), Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wanfang Database were searched. All randomized controlled trials (RCTs) comparing prophylacticuse of anticoagulant drugs and no use of anticoagulant drugs after knee arthroscopywere retrieved from the database establishment to September 2022.Trials involving the use of anticoagulants in the control group or nonpharmacologic anticoagulation in the experimental group were excluded. Two researchers independently screened the literature. The quality of the included literatures was evaluated and data were extracted. The incidence of pulmonary embolism (PE), symptomatic DVT, and asymptomatic proximal DVT of the lower extremities were selected as the observation indicators for efficacy, and the incidence of severe major bleeding and minor bleeding were selected as the observation indicators for safety. RevMan 5.4 software was used for meta-analysis.

Results

Eight RCTS involving 4 302 patients were included. There was no statistically significant difference in the incidence of pulmonary embolism (PE) between the prophylactic anticoagulation group and the non-anticoagulation group after knee arthroscopy [relative risk (RR)=1.36, 95% confidence interval (CI)(0.37, 4.97), P=0.64]. The incidence of symptomatic DVT in prophylactic anticoagulation group was significantly lower than that in non-anticoagulation group[RR=0.32, 95%CI(0.16, 0.63), P=0.001]. The incidence of asymptomatic proximal DVT in prophylactic anticoagulation group was significantly lower than that in non-anticoagulation group [RR=0.17, 95%CI (0.06, 0.48), P=0.0007]. There was no significant difference in the incidence of major hemorrhage between the two groups [RR=1.44, 95%CI(0.25, 8.14), P=0.68]. The incidence of minor hemorrhage in prophylactic anticoagulation group was higher than that in non-anticoagulation group, and the difference was statistically significant [RR=1.47, 95%CI(1.11, 1.94), P=0.006].

Conclusions

Prophylactic use of anticoagulants after knee arthroscopy can effectively reduce the incidence of symptomatic DVT and asymptomatic proximal DVT without increasing the risk of severe bleeding. However, the incidence of PE, symptomatic DVT and asymptomatic proximal DVT after knee arthroscopy is low regardless of whether anticoagulation is used or not. Clinicians should fully consider the risk factors of patients when deciding whether to take anticoagulation.

图1 文献筛选流程图
Figure 1 Flow diagram of literature screening
表1 纳入文献基本特征
Table 1 Basic characteristics of the included studies
图2 文献质量评估图
Figure 2 Quality assessment chart of the literatures
图3 两组患者膝关节镜术后PE(肺栓塞)发生率比较
Figure 3 Comparison of the incidence of PE after knee arthroscopy between the two groups
图4 两组患者膝关节镜术后有症状DVT(深静脉血栓)发生率比较
Figure 4 Comparison of the incidence of symptomatic DVT after knee arthroscopy between the two groups
图5 两组患者膝关节镜术后无症状下肢近端DVT(深静脉血栓)发生率比较
Figure 5 Comparison of the incidence of asymptomatic proximal lower extremity DVT after knee arthroscopy between the two groups
图6 两组患者膝关节镜术后严重出血发生率比较
Figure 6 Comparison of the incidence of severe hemorrhage after knee arthroscopy between the two groups
图7 两组患者膝关节镜术后轻微出血发生率比较
Figure 7 Comparison of the incidence of minor hemorrhage after knee arthroscopy between the two groups
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