Objective:The perioperative period of major orthopedic surgery is associated with a high risk of thrombosis,but the best chemopreventive agent for thrombosis prophylaxis is still inconclusive.For this reason,this pape...Objective:The perioperative period of major orthopedic surgery is associated with a high risk of thrombosis,but the best chemopreventive agent for thrombosis prophylaxis is still inconclusive.For this reason,this paper evaluated the efficacy and safety of aspirin versus low-molecular heparin using a Meta-analysis.Methods:Ten randomized controlled studies on the application of aspirin and low-molecular heparin for the prevention of deep vein thrombosis in orthopedic major surgery were retrieved by computer searches of PubMed,CochraneLibrary,WebofScience,China Knowledge Network,Wanfang,and Vipul databases according to inclusion and exclusion criteria,and the literature was managed using Endnote software,and the data were analyzed using Revman 5.3 software was used to perform Meta-analysis of the extracted data,focusing on the effects of these two drugs on pulmonary embolism,deep vein thrombosis,major bleeding events,minor bleeding events,wound complications,mortality and blood loss within 90 days after major orthopedic surgery.Results:(1)Ten randomized controlled trials of high quality were included,with a total of 12,974 patients,7,026 in the aspirin group and 5,948 in the low-molecular heparin group;(2)Meta-analysis showed that aspirin had a higher incidence of pulmonary embolism(OR=1.59,95%CI:1.02 to 2.49,P=0.04)and deep vein thrombosis(OR=1.60,95%CI:1.26 to 2.02,P=0.0001)than low molecular heparin;(3)The incidence of major bleeding events(OR=0.85,95%CI:0.47 to 1.55,P=0.60),minor bleeding events(OR=0.79,95%CI:0.55 to 1.12,P=0.18),adverse wound reactions(OR=0.79,95%CI:0.48 to 1.31,P=0.36),mortality within 90 days(OR=0.69,95%CI:0.20 to 2.31,P=0.55)and perioperative blood loss(MD=0.69,95%CI:0.20 to 2.31,P=0.55)in both drug groups,mortality within 90 days(OR=0.69,95%CI:0.20 to 2.31,P=0.55)and perioperative blood loss(MD=0.69,95%CI:0.20 to 2.31,P=0.55)were not statistically significant.Conclusion:Low-molecular heparin was superior to aspirin in the prevention of pulmonary embolism and lower extremity deep vein thrombosis after major orthopedic surgery,but the safety and adverse drug reactions of both groups were basically similar.Based on this,the authors recommend that low-molecular heparin should be preferred for the prevention of deep vein thrombosis in major orthopaedic surgery;however,the inclusion of randomized controlled trials remains limited,necessitating high-quality,large-sample,long-term follow-up clinical studies.展开更多
Our objective is to evaluate different pharmacologic strategies for VTE （venous thromboembolism） prophylaxis following orthopedic surgery at a tertiary academic medical center. This was a retrospective, observationa...Our objective is to evaluate different pharmacologic strategies for VTE （venous thromboembolism） prophylaxis following orthopedic surgery at a tertiary academic medical center. This was a retrospective, observational study assessing the efficacy and safety of different strategies for VTE prophylaxis in elective total knee arthroplasty and total hip arthroplasty surgery patients. We evaluated warfarin at two different INR （international normalized ratio） goal ranges （1.5-2.5 and 1.8-2.3） and aspirin 325 mg once or twice daily. The main efficacy outcome was a composite of symptomatic deep vein thrombosis or pulmonary embolism. The main safety outcome was incidence of major or minor bleeding. From January 2010 to June 2010, there were 190 patients in the warfarin group with INR range 1.5-2.5, 214 patients in the warfarin group with INR range 1.8-2.3, and 48 patients in the aspirin group. Of the three strategies, two primary events occurred in each of the warfarin groups （1.6% vs. 1.4%; P = 0.31）. There were no primary events in the aspirin group. Rates of major or minor bleeding were 4.2% in warfarin group INR 1.5-2.5 and 4.7% in warfarin group 1NR 1.8-2.3 （P = 0.19）, and 2.1% in the aspirin arm （P = 0.29）. There were no differences in the incidence of VTE in any of the treatment arms.展开更多
Background:Venous thromboembolism(VTE)is a common postoperative complication in orthopedic surgery and warrants the use of pharmacologic thromboprophylaxis.The purpose of this study was to analyze current prescribing ...Background:Venous thromboembolism(VTE)is a common postoperative complication in orthopedic surgery and warrants the use of pharmacologic thromboprophylaxis.The purpose of this study was to analyze current prescribing practices at our institution and to assess outcomes of pharmacologic strategies used for VTE prophylaxis following major orthopedic surgery.Methods:This was a single center,retrospective analysis at a tertiary academic medical center.Patients were included if they were admitted for total hip or knee arthroplasties and received pharmacologic thromboprophylaxis(warfarin INR goal 1.8-2.3,aspirin at variable doses,low molecular weight heparin(LMWH),DOAC)post-operatively from January 2017 to June 2017.Patients were excluded if they had a history of VTE or were on long-term anticoagulation.Major endpoints included incidence of thrombotic and bleeding events within 30 days post-surgery.Results:A total of 476 patients were screened;89 were excluded and 387 were included(warfarin=183,aspirin=201,LMWH=2,apixaban=1).Two patients in the warfarin group experienced a deep vein thrombosis compared with one patient in the aspirin group(p=0.51).Major bleeding occurred in one patient in the warfarin group and none in the aspirin group.Total bleeding rates occurred in 2.7%and 1.0%in the warfarin and aspirin groups,respectively.Conclusion:There has been an increase in the use of aspirin at our facility in postoperative orthopedic surgery patients without an increase in DOAC use.No difference was detected in safety and efficacy endpoints in our warfarin versus aspirin patients.展开更多
Objective To assess Chinese surgeon practice of thromboprophylaxis following major orthopedic surgery. Methods A questionnaire survey was conducted amongst Chinese orthopedic surgeons. A total of 293 surgeons were sur...Objective To assess Chinese surgeon practice of thromboprophylaxis following major orthopedic surgery. Methods A questionnaire survey was conducted amongst Chinese orthopedic surgeons. A total of 293 surgeons were surveyed concerning five key aspects of thromboembolic prophylaxis after major orthopedic surgery at the proseminar of Chinese guidelines for prevention of venous thromboembolism (VTE) after major orthopedic surgery in January of 2009. Results Totally, 208 surgeons (71.0%) responded, successfully completing the questionnaire. Of them, 57.6% respondents selected combined basic, mechanical, and pharmacologic methods for thromboprophylaxis; 51.0% respondents prefer starting prophylaxis 12-24 hours after surgery; 60.3% surgeons would use chemoprophylaxis for 7-10 days; 47.6% respondents prefer VTE prevention based on patients' special conditions and needs upon discharge. "Safety" was the most repeated and emphasized factor during VTE prophylaxis. Conclusions Multimodal thromboprophylaxis is frequently used after major orthopedic surgery. Half surgeons prefer to start chemoprophylaxis 12-24 hours after surgery. Thromboprophylaxis regimen varies for discharged patients.展开更多
基金Natural Science Foundation of Xinjiang Uygur Autonomous Region(No.2019D01C244)Special Research Project for Health and Young Medical Science and Technology Talents in Xinjiang Uygur Autonomous Region(No.WJWY-202142)。
文摘Objective:The perioperative period of major orthopedic surgery is associated with a high risk of thrombosis,but the best chemopreventive agent for thrombosis prophylaxis is still inconclusive.For this reason,this paper evaluated the efficacy and safety of aspirin versus low-molecular heparin using a Meta-analysis.Methods:Ten randomized controlled studies on the application of aspirin and low-molecular heparin for the prevention of deep vein thrombosis in orthopedic major surgery were retrieved by computer searches of PubMed,CochraneLibrary,WebofScience,China Knowledge Network,Wanfang,and Vipul databases according to inclusion and exclusion criteria,and the literature was managed using Endnote software,and the data were analyzed using Revman 5.3 software was used to perform Meta-analysis of the extracted data,focusing on the effects of these two drugs on pulmonary embolism,deep vein thrombosis,major bleeding events,minor bleeding events,wound complications,mortality and blood loss within 90 days after major orthopedic surgery.Results:(1)Ten randomized controlled trials of high quality were included,with a total of 12,974 patients,7,026 in the aspirin group and 5,948 in the low-molecular heparin group;(2)Meta-analysis showed that aspirin had a higher incidence of pulmonary embolism(OR=1.59,95%CI:1.02 to 2.49,P=0.04)and deep vein thrombosis(OR=1.60,95%CI:1.26 to 2.02,P=0.0001)than low molecular heparin;(3)The incidence of major bleeding events(OR=0.85,95%CI:0.47 to 1.55,P=0.60),minor bleeding events(OR=0.79,95%CI:0.55 to 1.12,P=0.18),adverse wound reactions(OR=0.79,95%CI:0.48 to 1.31,P=0.36),mortality within 90 days(OR=0.69,95%CI:0.20 to 2.31,P=0.55)and perioperative blood loss(MD=0.69,95%CI:0.20 to 2.31,P=0.55)in both drug groups,mortality within 90 days(OR=0.69,95%CI:0.20 to 2.31,P=0.55)and perioperative blood loss(MD=0.69,95%CI:0.20 to 2.31,P=0.55)were not statistically significant.Conclusion:Low-molecular heparin was superior to aspirin in the prevention of pulmonary embolism and lower extremity deep vein thrombosis after major orthopedic surgery,but the safety and adverse drug reactions of both groups were basically similar.Based on this,the authors recommend that low-molecular heparin should be preferred for the prevention of deep vein thrombosis in major orthopaedic surgery;however,the inclusion of randomized controlled trials remains limited,necessitating high-quality,large-sample,long-term follow-up clinical studies.
文摘Our objective is to evaluate different pharmacologic strategies for VTE （venous thromboembolism） prophylaxis following orthopedic surgery at a tertiary academic medical center. This was a retrospective, observational study assessing the efficacy and safety of different strategies for VTE prophylaxis in elective total knee arthroplasty and total hip arthroplasty surgery patients. We evaluated warfarin at two different INR （international normalized ratio） goal ranges （1.5-2.5 and 1.8-2.3） and aspirin 325 mg once or twice daily. The main efficacy outcome was a composite of symptomatic deep vein thrombosis or pulmonary embolism. The main safety outcome was incidence of major or minor bleeding. From January 2010 to June 2010, there were 190 patients in the warfarin group with INR range 1.5-2.5, 214 patients in the warfarin group with INR range 1.8-2.3, and 48 patients in the aspirin group. Of the three strategies, two primary events occurred in each of the warfarin groups （1.6% vs. 1.4%; P = 0.31）. There were no primary events in the aspirin group. Rates of major or minor bleeding were 4.2% in warfarin group INR 1.5-2.5 and 4.7% in warfarin group 1NR 1.8-2.3 （P = 0.19）, and 2.1% in the aspirin arm （P = 0.29）. There were no differences in the incidence of VTE in any of the treatment arms.
文摘Background:Venous thromboembolism(VTE)is a common postoperative complication in orthopedic surgery and warrants the use of pharmacologic thromboprophylaxis.The purpose of this study was to analyze current prescribing practices at our institution and to assess outcomes of pharmacologic strategies used for VTE prophylaxis following major orthopedic surgery.Methods:This was a single center,retrospective analysis at a tertiary academic medical center.Patients were included if they were admitted for total hip or knee arthroplasties and received pharmacologic thromboprophylaxis(warfarin INR goal 1.8-2.3,aspirin at variable doses,low molecular weight heparin(LMWH),DOAC)post-operatively from January 2017 to June 2017.Patients were excluded if they had a history of VTE or were on long-term anticoagulation.Major endpoints included incidence of thrombotic and bleeding events within 30 days post-surgery.Results:A total of 476 patients were screened;89 were excluded and 387 were included(warfarin=183,aspirin=201,LMWH=2,apixaban=1).Two patients in the warfarin group experienced a deep vein thrombosis compared with one patient in the aspirin group(p=0.51).Major bleeding occurred in one patient in the warfarin group and none in the aspirin group.Total bleeding rates occurred in 2.7%and 1.0%in the warfarin and aspirin groups,respectively.Conclusion:There has been an increase in the use of aspirin at our facility in postoperative orthopedic surgery patients without an increase in DOAC use.No difference was detected in safety and efficacy endpoints in our warfarin versus aspirin patients.
文摘Objective To assess Chinese surgeon practice of thromboprophylaxis following major orthopedic surgery. Methods A questionnaire survey was conducted amongst Chinese orthopedic surgeons. A total of 293 surgeons were surveyed concerning five key aspects of thromboembolic prophylaxis after major orthopedic surgery at the proseminar of Chinese guidelines for prevention of venous thromboembolism (VTE) after major orthopedic surgery in January of 2009. Results Totally, 208 surgeons (71.0%) responded, successfully completing the questionnaire. Of them, 57.6% respondents selected combined basic, mechanical, and pharmacologic methods for thromboprophylaxis; 51.0% respondents prefer starting prophylaxis 12-24 hours after surgery; 60.3% surgeons would use chemoprophylaxis for 7-10 days; 47.6% respondents prefer VTE prevention based on patients' special conditions and needs upon discharge. "Safety" was the most repeated and emphasized factor during VTE prophylaxis. Conclusions Multimodal thromboprophylaxis is frequently used after major orthopedic surgery. Half surgeons prefer to start chemoprophylaxis 12-24 hours after surgery. Thromboprophylaxis regimen varies for discharged patients.
