口服华法令预防肿瘤患者导管相关血栓有效性的系统评价

Oral Warfarin in Prevention of Catheter-related Thrombosis in Cancer Patients:A Systematic Review

目的系统评价口服华法令预防肿瘤患者导管相关血栓(CRT)的有效性,为临床预防肿瘤患者CRT提供相应实证。方法电子检索PUBMED/MEDLINE、OVID、EBSCO、EMBASE、中国生物医学文献数据库(CBM)、中国知网(CNKI),同时辅以引文检索和手工检索,收集随机对照试验的文献,按照纳入和排除标准,由两名研究者独立筛查文献、资料提取和质量评价。采用RevMan5.0统计软件进行Meta分析。结果经筛选共纳入6篇随机对照试验文献进行Meta分析,共1 522例肿瘤患者。Meta分析结果显示:口服华法令与安慰剂相比较,两组CRT发生率间差异有统计学意义[RR=0.68,95%CI(0.52,0.89),P=0.004],两组出血发生率和病死率差异无统计学意义,出血发生率[RR=2.12,95%CI(0.82,5.48),P=0.12],病死率[RR=1.01,95%CI(0.58,1.74),P=0.98]。结论口服华法令能有效降低肿瘤患者CRT的发生率,并不增加出血发生率和病死率。由于相关研究较少,尚需更多设计严格的大样本随机对照试验进一步增加证据的强度。

Objective To evaluate systematically the effectiveness of warfarin in prevention of catheter-related thrombosis（CRT） in cancer patients to provide corresponding evidence for CRT prevention.Methods Literatures of randomized controlled trials were collected by retrieving PUBMED/MEDLINE、OVID、EBSCO、EMBASE、CBM、CNKI,supplemented by citation and manual searches.The screened literature,extracted data and quality assessment done independently by 2 researchers were analyzed by RevMan5.0 statistical software using Meta-analysis.Results A total of 6 screened literatures of randomized controlled trials were analyzed by Meta-analysis and 1 522 cancer patients were found.There was significant difference in CRT incidence rate between groups oral warfarin and placebo [RR=0.68,95%CI（0.52,0.89）,P=0.004],but no difference was noted in bleeding incidence or mortality（P=0.98）.Conclusion Oral warfarin can reduce effectively CRT incidence in cancer patients,not increasing bleeding incidence and mortality.Because of fewer studies on it,more large samples of rigorously-designed randomized controlled trials are demanded for further evidences.