膝关节以下骨折静脉血栓栓塞的发生率有和没有化学血栓预防：系统回顾和荟萃分析

IF 2 3区医学 Q2 ORTHOPEDICS Archives of Orthopaedic and Trauma Surgery Pub Date : 2024-12-23 DOI:10.1007/s00402-024-05675-x

John T. Riehl, Noah J. Embry, Daniel G. Zeter, Cornelis J. Potgieter, McKenna W. Box

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引用次数: 0

摘要

在孤立的膝关节以下骨科创伤患者中发现了低发生率的静脉血栓栓塞（VTE）。然而，许多外科医生在这些损伤中常规提供化学血栓预防。这并非没有固有的风险，这在骨科创伤的围手术期护理中仍然是一个有争议的话题。这项系统回顾和荟萃分析是为了观察孤立的膝关节以下骨科骨折患者静脉血栓栓塞的发生率，并根据他们是否接受化学预防和未接受化学预防进行分组。方法对单纯膝关节以下骨科骨折患者静脉血栓栓塞治疗前后进行系统评价。然后对所有纳入的25篇文章中接受化学预防的患者和未接受化学预防的患者的数据进行卡方分析。文章根据研究类型进行分组，如观察性与随机对照试验（RCT），然后根据手术干预情况，以及是否使用常规血栓栓塞筛查进行诊断进一步细分。对队列研究使用ROBINS-I标准，对随机对照试验使用Cochrane RoB 2工具进行偏倚风险评估。然后进行随机效应合并逻辑回归和Fisher精确检验。结果25篇文献共发现222,188例患者。化学预防治疗8666例，发生静脉血栓栓塞347例（4.0%）。213522例患者未接受化学预防，2185例（1.02%）发生静脉血栓栓塞（VTE）（χ2 (1, n = 222188) = 656.8, p < .00001）。合并逻辑回归显示，接受预防的患者发生静脉血栓栓塞的可能性降低了0.5倍。计算出发生静脉血栓栓塞的人群基线风险为1.5%，用化学预防治疗（NNT）的人数为134人，以防止膝以下骨折后发生1例静脉血栓栓塞。结论孤立性膝以下骨科创伤患者，由于缺乏明显的疗效和较高的NNT，不建议滥用化学预防静脉血栓栓塞。证据等级：III级。

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Incidence of venous thromboembolism in fracture below the knee with and without chemical thromboprophylaxis: a systematic review and meta-analysis

Introduction

Low rates of venous thromboembolism (VTE) have been found in patients with isolated orthopaedic trauma below the knee. Many surgeons routinely provide chemical thromboprophylaxis in these injuries, however. This is not without inherent risks, and this remains a controversial topic in perioperative care in orthopaedic trauma. This systematic review and meta-analysis was performed to look at rates of VTE in patients with isolated orthopaedic fractures below the knee, grouped by whether they received chemical prophylaxis versus no chemical prophylaxis.

Methods

A systematic review was performed comparing VTE with and without chemical thromboprophylaxis following isolated orthopaedic fracture below the knee. A chi-square analysis was then performed on data including patients who received chemical prophylaxis versus those who did not from all 25 included articles. The articles were grouped according to type of study, such as observational versus randomized controlled trial (RCT), and then further subdivided according to surgical intervention status, and whether routine screening for thromboembolism was utilized to diagnose. Risk of bias assessment was performed using the ROBINS-I criteria for cohort studies and the Cochrane RoB 2 tool for randomized controlled trials. A random effects pooled logistic regression and Fisher’s exact tests were then performed.

Results

222,188 patients were found from 25 articles. Chemical prophylaxis was given to 8,666 patients, and VTE was reported in 347 cases (4.0%). 213,522 patients did not receive chemical prophylaxis, and VTE was reported in 2,185 (1.02%) (χ² (1, n = 222,188) = 656.8, p < .00001). Pooled logistic regression revealed that patients receiving prophylaxis were 0.5 times less likely to develop VTE. With a calculated population baseline risk of 1.5% for developing VTE, the number needed to treat (NNT) with chemical prophylaxis is 134 to prevent 1 VTE after fracture below the knee.

Conclusions

In patients with isolated orthopaedic trauma below the knee, indiscriminate use of chemical VTE prophylaxis is not recommended due to the lack of significant benefit and high NNT.

Level of Evidence

Level III.

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来源期刊

Archives of Orthopaedic and Trauma Surgery 医学-外科

CiteScore

4.30

自引率

13.00%

发文量

424

审稿时长

2 months

期刊介绍： "Archives of Orthopaedic and Trauma Surgery" is a rich source of instruction and information for physicians in clinical practice and research in the extensive field of orthopaedics and traumatology. The journal publishes papers that deal with diseases and injuries of the musculoskeletal system from all fields and aspects of medicine. The journal is particularly interested in papers that satisfy the information needs of orthopaedic clinicians and practitioners. The journal places special emphasis on clinical relevance. "Archives of Orthopaedic and Trauma Surgery" is the official journal of the German Speaking Arthroscopy Association (AGA).