抗栓药物对良性前列腺增生手术围术期出血影响的Meta分析

Antithrombotic agents and bleeding risk after transurethral therapy of benign prostatic hyperplasia:A Meta-analysis

目的系统评价应用抗栓药物对良性前列腺增生(BPH)手术围术期出血的影响。方法计算机检索Pubmed、Embase、Cochrane library、万方及中国知网数据库发表的有关BPH围术期抗凝治疗对术后出血影响的研究,检索时限为1990年1月至2018年5月。由2名评价者按照纳入与排除标准选择试验、提取资料和评价质量后,采用RevMan 5.3软件进行荟萃分析。结果纳入26篇研究,共4 314例患者,结果显示:TURP围术期持续服用抗栓药物与术前停用抗栓药物相比,术后出血风险大[OR=4.34,95%CI(2.29～8.23),P<0.000 01],输血率高[OR=2.96,95%CI(1.19～7.36),P=0.02];与从未服用抗栓药物相比,术后出血风险大[OR=5.52,95%CI(1.64～18.66),P=0.006]。激光BPH手术期间持续服用抗栓药物与术前停用抗栓药物相比,输血率高[OR=5.39,95%CI(1.49～19.53),P=0.01];与从未服用抗栓药物相比较,膀胱内血凝块残留率、输血率、术中血红蛋白下降值及术后留置导尿时间无明显差异(P>0.05);与低分子肝素替代相比较,术中血红蛋白下降值低[WMD=-0.46,95%CI(-0.58～-0.35),P<0.000 01]。结论 TURP围术期停用抗栓药物可以降低术后出血的风险;激光BPH手术围术期持续服用抗栓药物是安全可行的。

Objective To assess the effects of antithrombotic agents on the bleeding risk after transurethral resection of the prostate(TURP) in patients with benign prostatic hyperplasia(BPH).Methods Controlled clinical trials about the effects of perioperative anticoagulant therapy on postoperative bleeding in BPH patients published during Jan.1990 and May 2018 were searched in PubMed,Embase,the Cochrane Library,CNKI,and Wanfang Data.Two independent reviewers screened the studies according to the inclusion and exclusion criteria,extracted the data,evaluated the quality,and conducted a Meta-analysis using the RevMan 5.3 software.Results A total of 26 studies were included,with 4,314 cases involved.Analysis of these studies found that compared with interrupted use of antithrombotic agents,continuous use of antithrombotic drugs led to more frequent post-TURP bleeding [OR=4.34,95%CI(2.29-8.23),P<0.000 01],and higher transfusion rate [OR=2.96,95%CI(1.19-7.36),P=0.02].Compared with patients who never used antithrombotic agents,those who used antithrombotic agents continuously had higher bleeding risk [OR=5.52,95%CI(1.64-18.66),P=0.006].Those who continued using antithrombotic agents during laser treatment had higher transfusion rate than those who stopped using them before the operation [OR=5.39,95%CI(1.49-19.53),P=0.01],but had no significant differences in clot retention,blood transfusion rate,intraoperative hemoglobin decrease and postoperative catheter-indwelling time compared with those who never used antithrombotic agents(P>0.05).Those who continued using antithrombotic agents during TURP showed less intraoperative hemoglobin decrease [WMD=-0.46,95%CI(-0.58--0.35),P<0.000 01] than the patients who underwent low molecular weight heparin(LMWH) substitution.Conclusion Interruption of antithrombotic agents during TURP can prevent the risk of postoperative bleeding;continuous use of antithrombotic agents is safe and feasible during laser treatment of BPH;whether LMWH substitution is necessary during the discontinuation of antithrombotic agents is controversial.