Traditional Chinese medicine injection for promoting blood circulation in prevention of deep vein thrombosis after orthopedic surgery: network meta-analysis

doi:10.12307/2022.447

Abstract

Abstract: OBJECTIVE: Clinical studies have found that traditional Chinese medicine injections can effectively prevent deep vein thrombosis in patients after orthopedic surgery. However, there are many types of traditional Chinese medicine injections in clinical application, and there is still a lack of comparative studies among different types of injections. In this study, network meta-analysis was used to evaluate the efficacy and safety of traditional Chinese medicine injections for the prevention of deep vein thrombosis in patients after orthopedic surgery.
METHODS: Randomized controlled trials of traditional Chinese medicine injections for the prevention of deep vein thrombosis in patients after orthopedic surgery were searched from CNKI, Wanfang, VIP, Chinese Biomedical Literature Service System, PubMed, Embase and Cochrane Library until March 2021. Outcome indicators were the incidence of deep vein thrombosis, prothrombin time, activated partial thromboplastin time, fibrinogen, D-dimer, and safety evaluation (the occurrence of adverse reactions). The quality of the included articles was evaluated using the Cochrane Systematic Reviewer's Manual Version 5.1.0 randomized controlled trials risk of bias assessment tool and modified Jadad score. After data extraction, RevMan 5.3, Stata 16.0 and ADDIS 1.16.8 softwares were used for data analysis.
RESULTS: (1) A total of 1 685 articles were retrieved, and 67 randomized controlled trials involving a total of 6 052 patients were finally included, involving 11 kinds of Chinese medicine injections, and the intervention measures were all controlled studies of activating blood circulation combined with conventional western medicine and conventional western medicine. (2) The quality of the included articles was generally low, and the modified Jadad scores were all ≤ 3, indicating low quality studies. (3) The results of mesh meta-analysis showed that in terms of reducing the incidence of deep vein thrombosis, a total of 11 traditional Chinese medicine injections were involved, and the top three were conventional western medicine combined with Shuxuetong injection (0.440)> combined with Danhong injection (0.104) > combined with Safflower Yellow injection (0.103). In terms of prolongation of prothrombin time, a total of 10 traditional Chinese medicine injections were involved, and the top three best were conventional western medicine combined with Honghua injection (0.354) > combined with Danhong injection (0.275) > combined with Xuesaitong injection (0.109). In terms of prolongation of activated partial thromboplastin time, a total of nine traditional Chinese medicine injections were involved, and the top three were conventional western medicine combined with Honghua injection (0.405) > combined with Kudeizi injection (0.256) > combined with Danhong injection (0.098). In terms of reducing fibrinogen, a total of eight traditional Chinese medicine injections were involved, and the top three best were conventional western medicine combined with Kudezi injection (0.248) > combined with Xuesaitong injection (0.231) > combined with Honghua injection (0.216). In terms of reducing D-dimer, a total of 10 traditional Chinese medicine injections were involved, and the top three best were conventional western medicine combined with Miltiorrhiza and Ligustrazine injection (0.235) > combined with Shuxuetong injection (0.232) > combined with Kudezi injection (0.190). In terms of safety, a total of nine Chinese medicine injections were involved, and the top three were conventional western medicine combined with Ginkgo Leaf Extract and Dipyridamole injection (0.482), combined with Safflower Yellow injection (0.169) and combined with salvianolate injection (0.140).
CONCLUSION: Based on existing randomized controlled trial evidence: (1) On the basis of conventional application of western medicine, combined use of traditional Chinese medicine injection can effectively prevent deep vein thrombosis in patients after orthopedic surgery. (2) Shuxuetong injection was the best in reducing the incidence of deep vein thrombosis. Honghua injection was the best in prothrombin time and activated partial thromboplastin time. Kudeizi injection was the best in reducing fibrinogen. Miltiorrhiza and Ligustrazine injection was the best in reducing D-dimer. Ginkgo Leaf Extract and Dipyridamole injection was the best in safety evaluation.

Key words: traditional Chinese medicine injection, postoperative orthopedic surgery, deep vein thrombosis, clinical effect, security, network meta-analysis, prevention, randomized controlled trial

CLC Number:

Jing Jinpeng, Zhang Yue, Liu Xiaomin, Liu Yi. Traditional Chinese medicine injection for promoting blood circulation in prevention of deep vein thrombosis after orthopedic surgery: network meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(9): 1467-1476.

Figures/Tables 13

2.4 直接Meta分析结果研究中纳入的11种中药注射液联合常规西药与单独应用常规西药相比，能显著降低骨科患者术后的深静脉血栓发生率(P < 0.05)，且不良反应发生率无显著性差异(P > 0.05)；相较于给予骨科患者单独应用常规西药，联合丹参川芎嗪注射液、联合红花黄色素注射液、联合血栓通注射液和联合银杏达莫注射液能显著延长凝血酶原时间水平(P < 0.05)；联合丹参川芎嗪注射液、联合红花黄色素注射液和联合红花注射液能显著延长活化部分凝血酶原时间水平(P < 0.05)；联合红花注射液、联合苦碟子注射液、联合血塞通注射液、联合血栓通注射液和联合丹参多酚酸盐注射液能显著降低纤维蛋白原水平(P < 0.05)；联合丹参川芎嗪注射液、联合丹红注射液、联合红花注射液、联合疏血通注射液、联合血栓通注射液、联合丹参多酚酸盐注射液和联合银杏达莫注射液能显著降低D-二聚体水平(P < 0.05)。 Meta分析结果发现，在凝血酶原时间的比较中所纳入研究的异质性检验I2 均> 50%，分别进行敏感性分析以查找异质性来源：发现苦碟子注射液+常规西药 vs. 常规西药(G vs. A)的异质性主要来源于郑陈平等[55]的研究，将其剔除后，原本结局方向发生了改变。在活化部分凝血酶原时间的比较中，丹参川芎嗪注射液+常规西药 vs. 常规西药(B vs. A)、丹红注射液+常规西药 vs. 常规西药(D vs. A)、红花黄色素注射液+常规西药 vs. 常规西药(E vs. A)、G vs. A、血塞通注射液+常规西药 vs. 常规西药(I vs. A)、血栓通注射液+常规西药 vs. 常规西药(J vs. A)和银杏达莫注射液+常规西药 vs. 常规西药(L vs. A)的I2 > 50%，敏感性分析发现G vs. A，L vs. A的异质性分别来源于郑陈平等[55]和沈金明等[78]的研究，分别将其剔除后，原本结局指标的方向未发生改变；其他比较未明确找到异质性来源。在纤维蛋白原的比较中，B vs. A，D vs. A和J vs. A的I2 > 50%，敏感性分析发现J vs. A的异质性主要来源于张燕文等[65]的研究，将其剔除后，原本结局指标的方向未发生改变；其他比较未明确找到异质性来源。在D-二聚体的比较中，B vs. A，D vs. A，E vs. A，G vs. A，I vs. A和J vs. A的I2 > 50%，敏感性分析均未发现异质性的主要来源，见表2。"

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