基于阿司匹林的血栓预防与抗凝方案在全髋或全膝关节置换术后应用的比较：随机对照试验的更新系统评价与荟萃分析。
完整摘要 · 中文译文
背景与目的：阿司匹林广泛用于全髋关节置换术（THA）和全膝关节置换术（TKA）后的静脉血栓栓塞预防；然而，与抗凝方案相比，其疗效和安全性仍存在不确定性。本系统评价和meta分析评估了THA或TKA后以阿司匹林为基础的血栓预防与抗凝方案的比较。材料与方法：检索PubMed、Scopus、Web of Science和Cochrane对照试验中心注册库（CENTRAL），检索截止至2026年7月，纳入比较以阿司匹林为基础的预防与抗凝方案的随机对照试验。主要结局为任何深静脉血栓形成（DVT）、症状性DVT和症状性静脉血栓栓塞（VTE）。次要结局包括肺栓塞（PE）、近端和远端DVT、出血结局、伤口并发症、输血和死亡率。采用随机效应模型合并风险比（RR）及其95%置信区间（CI）。额外的风险差敏感性分析纳入了CRISTAL已发表的聚类校正估计值。结果：共纳入16项试验，涉及21,265名参与者。阿司匹林与更高的症状性DVT风险（RR 1.79，95% CI 1.35-2.38）、症状性VTE风险（RR 1.70，95% CI 1.33-2.18）、PE风险（RR 1.89，95% CI 1.33-2.68）和远端DVT风险（RR 1.47，95% CI 1.06-2.06）相关。阿司匹林与更低的轻微出血风险（RR 0.47，95% CI 0.31-0.71）和瘀斑或青紫风险（RR 0.60，95% CI 0.39-0.93）相关。未检测到统计学显著性差异f 或其他评估结局。纳入CRISTAL的聚类校正风险差异的额外分析未发现三种主要结局或肺栓塞（PE）存在统计学显著差异。结论：主要合并分析显示，以阿司匹林为基础的血栓预防与症状性血栓栓塞事件风险升高相关。然而，在排除CRISTAL或限制于低偏倚风险试验后，症状性深静脉血栓（DVT）和症状性静脉血栓栓塞（VTE）的关联不再具有统计学显著性。低风险分析发现，阿司匹林组任何DVT的风险显著更高。阿司匹林减少了轻微出血和瘀斑，但未在统计学上显著减少主要出血或临床相关非主要出血。鉴于结果对CRISTAL的依赖性、对试验纳入和分析方法的敏感性，以及预防策略和结局定义的差异，这些发现需谨慎解读。
完整摘要 · 英文原文
Background and Objectives: Aspirin is widely used for venous thromboembolism prophylaxis after total hip arthroplasty (THA) and total knee arthroplasty (TKA); however, uncertainty remains regarding its efficacy and safety compared with anticoagulant regimens. This systematic review and meta-analysis evaluated aspirin-based thromboprophylaxis versus anticoagulant regimens following THA or TKA. Materials and Methods: PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched through July 2026 for randomized controlled trials comparing aspirin-based prophylaxis with anticoagulant regimens. The primary outcomes were any deep vein thrombosis (DVT), symptomatic DVT, and symptomatic venous thromboembolism (VTE). Secondary outcomes included pulmonary embolism (PE), proximal and distal DVT, bleeding outcomes, wound complications, blood transfusion, and mortality. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Additional risk-difference sensitivity analyses incorporated CRISTAL's published cluster-adjusted estimates. Results: Sixteen trials involving 21,265 participants were included. Aspirin was associated with higher risks of symptomatic DVT (RR 1.79, 95% CI 1.35-2.38), symptomatic VTE (RR 1.70, 95% CI 1.33-2.18), PE (RR 1.89, 95% CI 1.33-2.68), and distal DVT (RR 1.47, 95% CI 1.06-2.06). Aspirin was associated with lower risks of minor bleeding (RR 0.47, 95% CI 0.31-0.71) and ecchymosis or bruising (RR 0.60, 95% CI 0.39-0.93). No statistically significant differences were detected for the other assessed outcomes. Additional analyses incorporating CRISTAL's cluster-adjusted risk differences did not identify statistically significant differences for the three primary outcomes or PE. Conclusions: The main pooled analyses associated aspirin-based thromboprophylaxis with higher risks of symptomatic thromboembolic events. However, the symptomatic DVT and symptomatic VTE associations were no longer statistically significant after exclusion of CRISTAL or restriction to trials at low risk of bias. The low-risk analysis identified a significantly higher risk of any DVT with aspirin. Aspirin reduced minor bleeding and bruising without a statistically significant reduction in major or clinically relevant non-major bleeding. These findings require cautious interpretation given dependence on CRISTAL, sensitivity to trial inclusion and analytical approach, and differences in prophylactic strategies and outcome definitions.