经导管直接溶栓联合抗凝与单纯抗凝治疗下肢深静脉血栓的Meta分析

Catheter-directed thrombolysis plus anticoagulation combined anticoagulation and simple anticoagulation for treatment of deep venous thrombosis: a Meta-analysis

目的评价经导管直接溶栓联合抗凝与单纯抗凝治疗下肢深静脉血栓形成的有效性和安全性。方法计算机检索Cochrane library、pub Med、Embase数据库,并辅以手工检索。对纳入的随机对照试验采用Rev Man 5.3软件进行Meta分析。结果 8个试验纳入研究。Meta分析结果显示,治疗后6个月,导管直接溶栓联合抗凝组髂股静脉通畅率高于单纯抗凝组(OR=6.22,95%CI:2.45~15.81,P<0.01),而髂股静脉功能性闭塞发生率及血栓形成后综合征发生率均低于单纯抗凝组(OR=0.21,95%CI:0.11~040,P<0.01;OR=2.42,95%CI:1.62~3.60,P<0.01),但两组之间的股静脉功能不全的发生率及远期深静脉血栓形成的复发率之间比较,差异无统计学意义(OR=0.76,95%CI:0.40~1.45,P=0.40;OR=0.55,95%CI:0.25~1.22),且导管直接溶栓联合抗凝组较单纯抗凝组,其大出血事件的发生率及肺动脉栓塞事件的发生率更高(Peto OR=1.27,95%CI:1.10~1.45,PP<0.01;Peto OR=1.68,95%CI:1.48~1.92,P<0.01)。结论经导管直接溶栓联合抗凝治疗相较于单纯抗凝治疗,可以有效的提高静脉通畅率,降低静脉闭塞的发生率,预防远期血栓形成后综合征的发生率;但选择经导管直接溶栓时,应充分评估其带来的出血风险。

Objective To evaluate the efficacy and safety of catheter-directed thrombolysis（ CDT） combined anticoagulation and simple anticoagulation（ Anticoagulant alone AC） for deep venous thrombosis. Methods We searched,added with Cochrane library、Pub Med、Embase database with hand searcing and other retrievals. The Cochrane Collaborations＇ Rev Man 5. 30 was used for Meta-analysis.Results Eight clinical trials were included in the study. Meta-analysis showed that after 6 month after the treatment,iliofemoral vein patency rate of CDT group was higher than that of AC group（ OR = 6. 22,95%CI： 2. 45 - 15. 81,P〈0. 01）,and the functional venous obstruction rate,PTS rate of CDT group was significant low than that in anticoagulation group（ OR = 0. 21,95% CI： 0. 11 - 040,P〈0. 01; OR = 2. 42,95% CI： 1. 62 - 3. 60,P〈0. 01）. However,the femoral vein insufficiency rate and recurrent rate of DVT were no statistic significance between the two groups（ OR = 0. 76,95% CI： 0. 40 - 1. 45,P = 0. 40; OR =0. 55,95% CI： 0. 25 - 1. 22）; Major bleeding complications and the rate of PE of CDT group compared to those of AC group were high,respectively（ Peto OR = 1. 27,95% CI： 1. 10 - 1. 45,P〈0. 01; Peto OR =1. 68,95% CI： 1. 48 - 1. 92,P〈0. 01）. Conclusion CDT plus anticoagulation appeared to be more effective than standard anticoagulation in improving venous patency and preventing venous obstruction and post-thrombotic syndrome despite of its high rate of PE and major bleeding. Caution should be taken when performing CDT,given the increase risk of major bleeding.