Aims We investigated the efficacy and safety profile of commonly used venous thromboembolism (VTE) prophylaxis agents following hip and knee arthroplasty. Methods A systematic search of PubMed, Embase, Cochrane Library, Web of Science, and OrthoSearch was performed. Prophylaxis agents investigated were aspirin (< 325 mg and ≥ 325 mg daily), enoxaparin, dalteparin, fondaparinux, unfractionated heparin, warfarin, rivaroxaban, apixaban, and dabigatran. The primary efficacy outcome of interest was the risk of VTE, whereas the primary safety outcomes of interest were the risk of major bleeding events (MBE) and wound complications (WC). VTE was defined as the confirmed diagnosis of any deep vein thrombosis and/or pulmonary embolism. Network meta-analysis combining direct and indirect evidence was performed. Cluster rank analysis using the surface under cumulative ranking (SUCRA) was applied to compare each intervention group, weighing safety and efficacy outcomes. Results Of 86 studies eligible studies, cluster rank analysis showed that aspirin < 325 mg daily (SUCRA-VTE 89.3%; SUCRA-MBE 75.3%; SUCRA-WC 71.1%), enoxaparin (SUCRA-VTE 55.7%; SUCRA-MBE 49.8%; SUCRA-WC 45.2%), and dabigatran (SUCRA-VTE 44.9%; SUCRA-MBE 52.0%; SUCRA-WC 41.9%) have an overall satisfactory efficacy and safety profile. Conclusion We recommend the use of either aspirin < 325 mg daily, enoxaparin, or dabigatran for VTE prophylaxis following hip and knee arthroplasty.

中文翻译：

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髋关节和膝关节置换术后常用血栓预防药物的功效和安全性。


目的 我们研究了髋关节和膝关节置换术后常用的静脉血栓栓塞 (VTE) 预防药物的有效性和安全性。方法 对 PubMed、Embase、Cochrane Library、Web of Science 和 OrthoSearch 进行系统检索。研究的预防药物包括阿司匹林（< 325 mg 和≥ 325 mg 每日）、依诺肝素、达肝素、磺达肝素、普通肝素、华法林、利伐沙班、阿哌沙班和达比加群。主要疗效结局是 VTE 风险，而主要安全结局是大出血事件 (MBE) 和伤口并发症 (WC) 风险。 VTE 被定义为任何深静脉血栓形成和/或肺栓塞的确诊。结合直接和间接证据进行了网络荟萃分析。使用累积排名表面（SUCRA）进行聚类排名分析来比较每个干预组，权衡安全性和有效性结果。结果 在 86 项合格研究中，聚类排名分析显示阿司匹林< 325 mg 每日（SUCRA-VTE 89.3%；SUCRA-MBE 75.3%；SUCRA-WC 71.1%）、依诺肝素（SUCRA-VTE 55.7%；SUCRA-MBE 49.8） %；SUCRA-WC 45.2%）和达比加群（SUCRA-VTE 44.9%；SUCRA-MBE 52.0%；SUCRA-WC 41.9%）具有总体令人满意的疗效和安全性。结论 我们建议每天使用阿司匹林 < 325 mg、依诺肝素或达比加群来预防髋关节和膝关节置换术后的 VTE。