Comparison between use of direct oral anticoagulants and aspirin for risk of thromboembolism complications in patients undergoing total knee and hip arthroplasty: a systematic review and meta-analysis.

OBJECTIVE: Total knee and hip arthroplasty are one of the most commonly consistently successful surgeries in orthopedics worldwide. Literature has reported that depending upon the age and co-existing treatments, patients undergoing total knee and hip arthroplasty are often prone to increased risks of developing venous thromboembolic complications. In such cases, chemoprophylaxis with either direct oral anticoagulant therapy with factor-Xa inhibitors (i.e., rivaroxaban, apixaban, dabigatran) and aspirin are widely recommended. Recent surveys suggest that direct oral anticoagulants and aspirin have comparable efficacy. However, there is no consensus in the literature as to which drug is the safest. Therefore, in this review, we shall attempt to evaluate the comparative efficacy between direct oral anticoagulant drugs and aspirin in patients undergoing total joint arthroplasty. To compare risk of venous thromboembolism complications between use of direct oral anticoagulant drugs and aspirin in patients undergoing total knee and hip arthroplasty. MATERIALS AND METHODS: A sensitive and specific analysis of the literature was performed according to the Cochrane and written according to PRISMA guidelines (Supplementary Table I). Five electronic databases (Web of Science, Embase, CENTRAL, Scopus, and Medline) were evaluated. To compare the efficacy between the drugs we conducted a random-effect meta-analysis according to the outcome (bleeding complications, venous thromboembolism or pulmonary embolism) and overall mortality in patients undergoing total knee and hip arthroplasty. RESULTS: Overall, 993 studies were found of which 117 had their full texts evaluated. A total of 161,463 patients undergoing total joint arthroplasty with mean age equal 66.2 ± 5.0 years were identified in 14 studies. Higher risks of venous thromboembolism (OR: 1.56 95% CI 1.21-2.01), pulmonary embolism (OR: 1.63, 95% CI: 1.31 -2.04) and overall mortality (OR: 1.35, 95% CI 1.04-1.74) for patients receiving aspirin were verified as compared to direct oral anticoagulant drugs. Subsequently, we further observed that the risks of bleeding complications (OR: 0.89 95% CI 0.67-1.18) were insignificant. CONCLUSIONS: The study reports higher risks of venous thromboembolism, pulmonary embolism, and overall mortality for the patients receiving aspirin before undergoing.

Does prior arthroscopic procedure impact outcomes of knee arthroplasty? A systematic review and meta-analysis.

OBJECTIVE: Despite generally favorable outcomes following knee arthroscopy, a certain subset of patients inevitably develops progression of knee disease, necessitating subsequent total knee arthroplasty (TKA). Therefore, the evaluation of TKA outcomes following arthroscopy has emerged as a major area of research. The aim of the current review is to measure the impact of prior arthroscopy on functional and adverse outcomes following TKA. MATERIALS AND METHODS: Literature search was conducted in the databases including Medline, EMBASE, PubMed Central, ScienceDirect, Google Scholar and Cochrane library from inception until April 2021. Meta-analysis with random-effects model was conducted to calculate pooled odds ratio (OR) or standardized mean difference (SMD) with 95% confidence interval (CI) depending on the type of outcome. RESULTS: In total, 9 studies with 185,013 participants were included in the review. The majority of the studies were conducted in the USA and China. Almost all the studies had low quality as per Newcastle Ottawa (NO) scale. The pooled SMD for functional outcome was -0.19 [95%CI: -0.30 to -0.09], while the pooled OR for revision rate was 1.53 (95% CI: 1.21 to 1.92). In terms of postoperative complications, the pooled OR for stiffness was 1.55 (95% CI: 0.92-2.61), infection was 1.39 (95%CI: 1.17-1.67), aseptic loosening was 1.93 (95% CI: 1.19-3.11), VTE was 1.06 (95% CI: 0.83-1.35), and MUA was 1.33 (95% CI: 1.13-1.57) respectively. CONCLUSIONS: Prior arthroscopy has significant impact on the functional and adverse clinical outcomes following TKA. Surgeons need to develop a comprehensive intervention plan to manage these high-risk patients and reduce the rate of postoperative complications.

Impact of biologic disease-modifying antirheumatic drugs on fracture risk in patients with rheumatoid arthritis: a systematic review and meta-analysis.

OBJECTIVE: This systematic review aimed to assess the impact of biologic disease-modifying antirheumatic drugs (bDMARDs) use on the risk of fracture in rheumatoid arthritis (RA) by conducting a pooled analysis of adjusted outcomes from individual studies. MATERIALS AND METHODS: PubMed, Embase, and BioMed Central were searched up to 20th January 2021. Multivariable-adjusted odds ratios (OR) or matched estimates on the impact of bDMARDs on fracture risk were pooled. RESULTS: Nine studies were included. We found no statistically significant difference in the risk of fractures in RA patients using bDMARDs vs. non-users. On sensitivity analysis, we found no change in the significance of the effect size on exclusion of any study. There was no statistically significant difference in fracture risk in studies only on tumor necrosis factor (TNF) inhibitors, as well as those including any bDMARDs. Pooled analysis of only three studies indicated a statistically significant reduction in vertebral fractures in bDMARD users vs. non-users. CONCLUSIONS: Within the ambit of several limitations of our review, there seems to be no impact of bDMARDs on the fracture risk in RA patients. Further studies evaluating the type and duration of bDMARD therapy with meticulous adjustment of confounding factors are required to strengthen current evidence.

Facile one-pot synthesis of multi-yolk-shell Bi@C nanostructures by the nanoscale Kirkendall effect.

Multi-yolk-shell Bi@C nanostructures were prepared via a facile one-pot template-free hydrothermal approach. The prepared Bi@C nanostructures can act as a solid catalyst in the thermal decomposition of cyclotrimethylenetrinitramine (RDX) and display excellent catalytic activity, which highlights their application in the field of energetic materials.