阿司匹林用于骨科术后静脉血栓栓塞症预防——临床证据进展与指南的变化

Aspirin for thromboprophylaxis in orthopedic surgery:advancements in clinical evidence and guidelines

骨科手术患者是静脉血栓栓塞症(VTE)的高危人群,围手术期使用抗凝药物预防VTE已经成为临床共识。全球的VTE预防指南在抗凝药物的推荐上各有侧重,比较一致的推荐是首选低分子肝素(LMWH)预防,其次是普通肝素、磺达肝癸钠、华法林、阿司匹林及其他新型口服抗凝药(DOACs)。其中阿司匹林是一种价格便宜、并发症少且广泛使用的抗血小板药物,在预防心肌梗死、卒中和某些特殊癌症方面疗效明确,早期也被应用于骨科术后VTE预防。北美地区较多研究结果显示阿司匹林对预防VTE有效并一直被沿用至今,但欧亚地区则较少使用阿司匹林预防VTE。阿司匹林在VTE预防中的作用和效果存在较大争议,早期与近期的研究结论相反,指南推荐也互相矛盾。故本文将围绕阿司匹林对骨科手术后VTE预防的临床证据与指南推荐进行文献综述。

As patients undergoing orthopedic surgery are a high-risk group for venous thromboembolism(VTE),clinical guidelines suggest anticoagulant drugs for VTE prophylaxis during perioperative period.Global antithrombotic guidelines vary in recommendations for anticoagulant drugs,but there is a general consensus in favor of using low-molecular-weight heparin(LMWH)as the first choice for prophylaxis,followed by unfractionated heparin,fondaparinux,warfarin,aspirin,and other direct oral anticoagulants(DOACs).Of them,aspirin is an inexpensive,widely used antiplatelet drug with limited complications and clear efficacy in prevention of myocardial infarction,stroke,and certain specific cancers.It was also used early for venous thromboembolism prophylaxis in orthopedic patients after surgery.Clinical experience of orthopedic physicians in North America has shown the effectiveness of aspirin in VTE prevention over several decades so that aspirin continues to be used to this day,but its use for VTE prophylaxis is less common in Europe and Asia.Historically,the role and efficacy of aspirin in VTE prevention have been the subjects of considerable controversy,for the early and recent research findings contradict each other,and recommendations conflict in different guidelines.This review focuses on the advancements in clinical evidence and guideline recommendations regarding the use of aspirin for VTE prophylaxis in major orthopedic surgeries.