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目的对利伐沙班与依诺肝素预防全髋关节置换术(THA)后深静脉血栓形成(DVT)的累积Meta分析,旨在评价两者的有效性和安全性。方法检索The Cochrane Library、Web of Science、EMBASE、EBSCO、PubMed、CNKI、万方、维普和CBM等数据库关于利伐沙班与依诺肝素预防THA后DVT的随机对照研究(RCTs),根据Cochrane 5.1手册要求,筛选文献、提取数据并评价研究质量,并使用RevMan 5.3和Stata 11.0软件进行累积Meta分析。结果纳入9项研究,共9 863例患者。累积Meta分析显示:利伐沙班预防THA后DVT事件发生率低于依诺肝素,但随时间变化,OR的点值估计和95%的可信区间趋势不稳定;临床大出血事件发生率随着时间和样本量变化,利伐沙班高于依诺肝素;临床小出血事件发生率现有证据显示两者差异无统计学意义,但随时间和样本量变化,利伐沙班可能会高于依诺肝素。结论利伐沙班预防THA后DVT事件发生率低于依诺肝素,临床小出血事件差异无统计学意义,但临床大出血发生率要高于依诺肝素,需更多多中心和大样本的临床随机对照研究来验证。
Abstract：AIM To evaluate effectiveness and safety of rivaroxaban and enoxaparin for the prevention of deep vein thrombosis(DVT) of total hip arthroplasty(THA) by cumulative Meta-analysis. METHODS Randomized controlled trials of rivaroxaban and enoxaparin for the prevention of DVT of THA were searched in the Cochrane Library, Web of Science, EMBASE, EBSCO, PubMed, CNKI, Wanfang database, VIP database and Chinese biomedical database(CBM). According to the Cochrane Handbook 5.1, literature was screened, data were extracted and the RCTs quality was evaluated. And Meta-analysis was performed by Revman 5.3 software and Stata 11.0 software. RESULTS A total of 9 863 patients were included in 9 studies. The cumulative Meta-analysis showed that: rivaroxaban for DVT incidence was lower than that of enoxaparin. But with time changed, OR and 95%CI was instability. With time and sample volume changed, incidence of massive hemorrhage events caused by rivaroxaban was more than that of enoxaparin. The incidence of clinical minor bleeding events showed no significant difference, but with time and sample volume changed, rivaroxaban might be higher than enoxaparin. CONCLUSION The incidence of DVT events after THA is lower than enoxaparin, and there is no statistical difference in clinical small bleeding events. However, the incidence of massive hemorrhage events is higher than enoxaparin, and more multicenter and large sample clinical randomized controlled studies were needed to verify.
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基本信息:
DOI：10.19577/j.1007-4406.2019.04.011
中图分类号:R687.4
引用信息:
[1]徐锦龙,水豪杰,王井玲,等.利伐沙班与依诺肝素预防全髋关节置换术后深静脉血栓形成的累积Meta分析[J].中国临床药学杂志,2019,28(04):286-290.DOI:10.19577/j.1007-4406.2019.04.011.
基金信息:
宁波市鄞州区科技计划项目(编号2016-29)
2019-07-25
2019-07-25