Effects of body weight on the efficacy and safety of oral anticoagulants for the prevention of VTE after hip and knee arthroplasty：a meta-analysis
- VernacularTitle:体质量影响髋膝关节置换术后口服抗凝药物预防VTE有效性和安全性的Meta分析
- Author:
Yao YUAN
1
;
Xinyu LI
1
;
Xuefeng SHAN
1
;
Feng QIU
1
Author Information
1. Dept. of Pharmacy，the First Affiliated Hospital of Chongqing Medical University，Chongqing 400010，China
- Publication Type:Journal Article
- Keywords:
body weight;
arthroplasty;
venous thromboembolism;
novel oral anticoagulants;
aspirin;
meta-analysis
- From:
China Pharmacy
2022;33(23):2895-2900
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To systematically review the effects of body weight on the efficacy and safety of novel oral anticoagulants （NOACs） or aspirin for the prevention of venous thromboembolism （VTE） after total hip arthroplasty and total knee arthroplasty （hereinafter referred to as “hip and knee arthroplasty”）. METHODS Retrieved from PubMed， Embase and Cochrane library， randomized controlled trial （RCT） and non-RCT about the effectiveness and/or safety of NOACs， aspirin and low- molecular heparin by subgrouping according to body weight or body weight index [BMI 18.5-＜25 kg/m2 as normal body mass， BMI 25-30 kg/m2 as overweight， and BMI＞30 kg/m2 as obesity （of them， BMI＞40 kg/m2 as morbid obesity）] were collected from the inception to June 30， 2022. After literature screening and data extraction， the quality of RCT was evaluated with bias risk assessment tool RoB 2.0 recommended by Cochrane system evaluator manual. The Newcastle-Ottawa scale was used to evaluate the quality of non-RCT. Meta-analysis was performed by using RevMan 5.4 software. RESULTS A total of 6 literatures， containing 3 series of RCT pooled studies and 3 non-RCTs were included. The results of meta-analysis showed that among different BMI subgroups， there was no statistical significance in reducing major VTE and VTE-related mortality of patients with normal body mass patients [OR＝0.63， 95%CI（0.26，1.51），P＝0.30]， overweight patients [OR＝0.48，95%CI（0.22，1.04），P＝0.06] and obese patients [OR＝0.70，95%CI（0.40，1.25），P＝0.23] by NOACs， compared with enoxaparin. The safety of NOACs was comparable to that of enoxaparin in different BMI subgroups in terms of the incidence of major bleeding events and major+clinically relevant non- major bleeding events （P＞0.05）. There was no statistical significance in the incidences of total VTE [OR＝1.28， 95%CI （0.68，2.40）， P＝0.45]， symptomatic VTE and all-cause mortality [OR＝1.26， 95%CI （0.81，1.95）， P＝0.30] and major bleeding [OR＝0.79， 95%CI （0.58，1.08）， P＝0.14] in obese/morbidly obese patients using NOACs and aspirin， compared with normal/overweight patients. CONCLUSIONS The impact of body weight on the efficacy and safety of NOACs and aspirin for the prevention of VTE after hip and knee arthroplasty is not significant， and this study supports that overweight and obese patients receive NOACs or aspirin for VTE prevention.
