药物预防关节置换术后静脉血栓栓塞网状Meta分析

EFFECT OF DRUGS IN THE PREVENTION OF VENOUS THROMBOEMBOLISM AFTER ARTHROPLASTY: A NETWORK META-ANALYSIS

目的应用网状Meta分析方法比较利伐沙班、肝素、阿哌沙班、达比加群酯4种药物预防静脉血栓栓塞(VTE)的临床疗效,以期为临床选择膝关节或髋关节置换术后最佳的VTE预防药物提供指导。方法以"髋关节置换"、"膝关节置换"、"静脉血栓栓塞"、"VTE"、"利伐沙班"、"肝素"、"阿哌沙班"、"达比加群酯"为关键词,从万方、维普、知网、PubMed、Cochrane Library和Embase等中英文数据库中检索相关研究性论文,检索时间设定为从数据库建库到2019年5月。提取数据进行网状Meta分析,比较利伐沙班、肝素、阿哌沙班、达比加群酯4种药物预防VTE的临床疗效。结果共检索到6 834篇文献,经过筛选收录了25项研究,包含40 438例病人。网状Meta分析显示,利伐沙班预防膝关节或髋关节置换术后VTE的效果优于肝素和达比加群酯,利伐沙班和阿哌沙班预防膝关节或髋关节置换术后VTE的疗效差异无统计学意义(P>0.05),阿哌沙班和达比加群酯预防膝关节或髋关节置换术后VTE的疗效差异也无统计学意义(P>0.05)。由SUCRA曲线预测的药效排序为:利伐沙班>阿哌沙班>达比加群酯>肝素。结论预防膝关节或髋关节置换术后VTE的推荐药物为利伐沙班和阿哌沙班,其次是达比加群酯和肝素。

Objective To investigate the effect of rivaroxaban,heparin,apixaban,and dabigatran in preventing venous thromboembolism(VTE)using a network Meta-analysis,and to provide guidance for clinicians to select the best drug for VTE prevention after knee or hip arthroplasty.Methods Related Chinese and English databases,such as Wanfang Data,VIP,CNKI,PubMed,Cochrane Library,and Embase,were searched for related research articles published up to May 2019,with the key words of“hip arthroplasty”,“knee arthroplasty”,“venous thromboembolism”,“VTE”,“rivaroxaban”,“heparin”,“apixaban”,and“dabigatran”.Related data were extracted for the network Meta-analysis,and the clinical effect of rivaroxaban,heparin,apixaban,and dabigatran in the prevention of VTE was compared.Results A total of 6834 articles were obtained and 25 studies were included after screening,with a total of 40438 patients.The network Meta-analysis showed that rivaroxaban had a better effect than heparin and dabigatran in preventing VTE after knee or hip arthroplasty,while there were no significant differences between the preventive effects of rivaroxaban and apixaban and between those of apixaban and dabigatran.The surface under the cumulative ranking curve showed that rivaroxaban had the best effect,followed by apixaban,dabigatran,and heparin.Conclusion Rivaroxaban and apixaban are recommended for the prevention of VTE after knee or hip arthroplasty,followed by dabigatran and heparin.