Abstract
BackgroundChinese herbal medicine has traditionally been considered to promote blood circulation to remove obstruction in the channels and clear pathogenic heat to drain dampness effects. We conducted this meta-analysis to evaluate its benefits for the prevention of deep venous thrombosis (DVT) after lower extremity orthopedic surgery.MethodsRelevant, published studies were identified using the following keywords: lower extremity orthopedic surgery, arthroplasty, joint replacement, fracture, traditional Chinese and western medicine, Chinese herbal medicine, deep venous thrombosis (DVT), and Venous thromboembolism (VTE). The following databases were used to identify the literature consisting of RCTs with a date of search of 31 May 2017: PubMed, Cochrane Library, Web of knowledge, the Chinese National Knowledge Infrastructure Database, the Chongqing VIP Database, the Chinese Biomedical Database, and the Wanfang Database (including three English and four Chinese databases). All relevant data were collected from studies meeting the inclusion criteria. The outcome variables were the incidence rate of DVT, activated partial thromboplastin time (APTT), prothrombin time (PT), and d-dimer; subcutaneous hematoma; and other reported outcomes. RevMan5.2. software was adopted for the meta-analysis.ResultsA total of 20 published studies (1862 cases) met the inclusion criteria. The experimental group, 910 patients (48.87%), received the Chinese herbal medicine or traditional Chinese and western medicine for prevention of DVT; the control group, 952 patients (51.13%), received the standard western treatment. The meta-analysis showed that traditional Chinese and western medicine therapy reduced the incidence rates of DVT significantly when compared with controls (risk ratio [RR] = 0.40; 95% CI, 0.30 to 0.54; P < 0.00001), and the d-dimer was lower in the experimental group (P = 0.01). Besides, the incidence rate of subcutaneous hematoma was lower in the experimental group (P < 0.0001). However, no significant difference was found in the PT (P = 0.98) and APTT (P = 0.75) in two groups. No serious adverse events were reported.ConclusionTraditional Chinese and western medicine therapy may be a safe, effective prevention modality for DVT after lower extremity orthopedic surgery. Further rigorously designed, randomized trials are warranted.
Highlights
Chinese herbal medicine has traditionally been considered to promote blood circulation to remove obstruction in the channels and clear pathogenic heat to drain dampness effects
Deep vein thrombosis (DVT) is one of the most common complications after lower extremity orthopedic surgery, several patients may develop into pulmonary embolism (PE), and some serious can lead to death [1, 2]
The pooled analysis indicated that statistical heterogeneity was found among studies (PT: I2 = 92%, P < 0.00001; activated partial thromboplastin time (APTT): I2 = 98%, P < 0.00001; difference of Ddimer between the two groups (D-dimer): I2 = 83%, P < 0.00001); the results showed there are no statistical difference of prothrombin time (PT) and APTT between the two groups (PT: MD = 0.01, 95% confidence intervals (CI): − 0.56 to 0.58, P = 0.98, Fig. 3; APTT: MD = − 0.71, 95% CI: − 4.97 to 3.54, P = 0. 74, Fig. 4)
Summary
Chinese herbal medicine has traditionally been considered to promote blood circulation to remove obstruction in the channels and clear pathogenic heat to drain dampness effects. We conducted this meta-analysis to evaluate its benefits for the prevention of deep venous thrombosis (DVT) after lower extremity orthopedic surgery. Deep vein thrombosis (DVT) is one of the most common complications after lower extremity orthopedic surgery, several patients may develop into pulmonary embolism (PE), and some serious can lead to death [1, 2]. Traditional Chinese medicine theory holds that DVT is the category of “pulse closed” and “femoral swelling,” and the main treatment is to promote blood circulation to remove blood stasis. The advantages of the combination of traditional Chinese and western medicine are becoming more and more prominent in the treatment and prevention of thrombotic diseases
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