Ⅹa因子抑制剂预防和治疗癌症患者静脉血栓栓塞有效性和安全性的Meta分析
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篇名: Ⅹa因子抑制剂预防和治疗癌症患者静脉血栓栓塞有效性和安全性的Meta分析
TITLE: Meta-analysis of the Efficacy and Safety of Ⅹa Factor Inhibitors in the Prevention and Treatment of Venous Thromboembolism in Cancer Patients
摘要: 目的:系统评价Ⅹa因子抑制剂(阿哌沙班、利伐沙班、依度沙班)预防和治疗癌症患者静脉血栓栓塞的有效性和安全性,为临床合理用药提供循证参考。方法:计算机检索Cochrane图书馆、PubMed、Embase、中国生物医学文献数据库、中国知网、维普数据库和万方数据库,收集Ⅹa因子抑制剂(试验组)对比常规治疗或安慰剂(对照组)预防和治疗癌症患者静脉血栓栓塞的随机对照试验(RCT)。筛选文献、提取资料并按Cochrane系统评价员手册5.1.0推荐的偏倚风险评估工具评价文献质量后,采用RevMan5.3软件进行Meta分析。结果:共纳入7项RCT,共计5666例患者。Meta分析结果显示,试验组患者静脉血栓栓塞复发率显著低于对照组[RR=0.58,95%CI(0.47,0.71),P<0.00001],两组患者大出血发生率[RR=1.12,95%CI(0.67,1.85),P=0.67]、临床相关的非主要出血发生率[RR=1.06,95%CI(0.72,1.55),P=0.77]比较,差异均无统计学意义。结论:Ⅹa因子抑制剂能有效降低癌症患者静脉血栓栓塞的复发风险,其安全性与常规治疗(安慰剂)相当。
ABSTRACT: OBJECTIVE:To systematicall y evaluate the efficacy and safety of a new oral anticoagulant Ⅹ a inhibitor (apixaban,rivaroxaban,edoxaban)in the prevention and treatment of venous thromboembolism (VTE)in cancer patients ,and to provide evidence-based reference for rational use of drugs in clinic. METHODS :Retrieved from Cochrane Library ,PubMed, Embase,CBM,CNKI,VIP and Wanfang database ,randomized controlled trials (RCTs)about Ⅹa inhibitor (trial group )versus routine treatment or placebo (control group )in the prevention and treatment of VTE in cancer patients were collected. After literature screening ,data extraction and quality evaluation was evaluated by using biasrisk evaluation tool recommended by Cochrane System Evaluator M anual 5.1.0,and Meta-analysis was conducted by using Rev Man 5.3 software. RESULTS :A total of 7 RCTs were included ,including 5 666 patients. Meta-analysis showed that recurrent rate of VTE in trial group was significantly lower than control group [RR =0.58,95%CI(0.47,0.71),P<0.000 01];there was no statistical significance in the incidence of major bleeding [RR =1.12,95%CI(0.67,1.85),P=0.67] and clinically relevant non-major bleeding [RR =1.06,95%CI(0.72,1.55), P=0.77] between 2 groups. CONCLUSIONS :Ⅹa inhibitors can effectively reduce the recurrent risk of VTE in cancer patients , safety comparable with routine treatment (placebo).
期刊: 2020年第31卷第06期
作者: 张嘉俊,杨琰茗,杨雅清,李珊珊,翁稚颖
AUTHORS: ZHANG Jiajun,YANG Yanming ,YANG Yaqing ,LI Shanshan ,WENG Zhiying
关键字: Ⅹa因子抑制剂;癌症;静脉血栓栓塞;Meta分析;有效性;安全性
KEYWORDS: Ⅹa inhibitors ;Cancer;Venous thromboe mbolism;Meta-analysis;Efficacy;Safety
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