Meta-analysis of cause of death following total joint replacement using different thromboprophylaxis regimens
Meta-analysis of cause of death following total joint replacement using different thromboprophylaxis regimens
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DOI：
10.1302/0301-620x.94b1.27301
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发表时间：
2012-01-01
影响因子：
--
通讯作者：
Salvati, E.
中科院分区：
文献类型：
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作者：
Poultsides, L. A.;Della Valle, A. Gonzalez;Salvati, E.
我们对现代全关节置换术（TJR）进行了一项荟萃分析，以确定使用不同血栓预防方案的术后死亡率和死亡原因：1）无常规化学血栓预防（NRC）; 2）有效抗凝（PA）（未分级或低分子量肝素、希美肝素、磺达肝素或利伐沙班）; 3）强效抗凝联合（PAC）局部麻醉和/或气动加压装置（PCD）; 4）Warcantine（W）; 5）Warcantine联合（WAC）局部麻醉和/或PCD;和6）多模式（MM）预防，包括低风险患者的区域麻醉，PCD和阿司匹林。死因被分类为尸检证实、临床确定或未知。死亡分为心肺（不包括肺栓塞（PE））、PE、出血相关、胃肠道、中枢神经系统和其他（其他）。采用基于固定效应或随机效应模型的Meta分析方法汇总发病率数据，共纳入70项研究（99441例患者，373例死亡）。MM组（0.2%）和WC组（0.2%）的死亡率最低。最常见的死亡原因是心肺（47.9%），其次是PE（25.4%）和出血（8.9%）。血栓预防方案对PE死亡比例没有显着影响（PA，35.5%; PAC，28%; MM，23.2%;和NRC，16.3%）。依赖抗凝治疗组的致死性出血率较高（W，33.8%; PA，9.4%; PAC，10.8%），但差异无统计学意义。我们的研究表明，常规使用PA并不能降低总死亡率或因PE死亡的比例。
We performed a meta-analysis of modern total joint replacement (TJR) to determine the post-operative mortality and the cause of death using different thromboprophylactic regimens as follows: 1) no routine chemothromboprophylaxis (NRC); 2) Potent anticoagulation (PA) (unfractionated or low-molecular-weight heparin, ximelagatran, fondaparinux or rivaroxaban); 3) Potent anticoagulation combined (PAC) with regional anaesthesia and/or pneumatic compression devices (PCDs); 4) Warfarin (W); 5) Warfarin combined (WAC) with regional anaesthesia and/or PCD; and 6) Multimodal (MM) prophylaxis, including regional anaesthesia, PCDs and aspirin in low-risk patients. Cause of death was classified as autopsy proven, clinically certain or unknown. Deaths were grouped into cardiopulmonary excluding pulmonary embolism (PE), PE, bleeding-related, gastrointestinal, central nervous system, and others (miscellaneous). Meta-analysis based on fixed effects or random effects models was used for pooling incidence data.In all, 70 studies were included (99 441 patients; 373 deaths). The mortality was lowest in the MM (0.2%) and WC (0.2%) groups. The most frequent cause of death was cardiopulmonary (47.9%), followed by PE (25.4%) and bleeding (8.9%). The proportion of deaths due to PE was not significantly affected by the thromboprophylaxis regimen (PA, 35.5%; PAC, 28%; MM, 23.2%; and NRC, 16.3%). Fatal bleeding was higher in groups relying on the use of anticoagulation (W, 33.8%; PA, 9.4%; PAC, 10.8%) but the differences were not statistically significant.Our study demonstrated that the routine use of PA does not reduce the overall mortality or the proportion of deaths due to PE.