低分子肝素联合物理治疗预防妇科肿瘤术后下肢深静脉血栓形成的网状Meta分析

Low molecular weight heparin plus physiotherapy techniques in prevention of deep vein thrombosis in gynecological cancer patients undergoing major abdominopelvic surgery: a network Meta-analysis

目的 运用网状Meta分析方法系统评价低分子肝素(low molecular weight heparin,LMWH)联合物理治疗预防妇科肿瘤术后下肢深静脉血栓形成(deep vein thrombosis,DVT)的有效性和安全性。方法 计算机检索PubMed、The Cochrane Library、Embase、Web of Science、万方和中国知网数据库中关于预防妇科肿瘤患者术后DVT有效性和安全性的研究,检索时限均从建库至2021年3月31日。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,应用RevMan 5.4、Stata 14.0软件进行网状Meta分析。结果 共纳入21篇RCT,涉及4 007例患者。结果显示LMWH联合逐级加压弹力袜(graduated compression stockings,GCS)或间歇充气加压装置(sequential compression devices,SCD)预防DVT的疗效均优于单用药物预防或物理干预,且LMWH联合GCS对比LMWH联合SCD疗效差异无统计学意义。LMWH与普通肝素(unfractionated heparin,UH)在DVT发生率与出血事件发生率方面差异均无统计学意义。结论 LMWH联合GCS或SCD是预防妇科肿瘤患者术后DVT的最佳方式,两者疗效相当,LMWH和UH具有同等的疗效,且出血事件发生率相似。受纳入研究数量和质量限制,上述结论尚需更多高质量、多中心的研究予以验证。

Objective To systematically review the efficacy and safety of low molecular weight heparin(LMWH) plus physiotherapy techniques in the prevention of deep vein thrombosis(DVT) among gynecological cancer patients undergoing major abdominopelvic surgery using a network analysis. Methods We electronically searched PubMed, The Cochrane Library, Embase, Web of Science, WanFang Data and CNIK for randomized controlled trials(RCTs) on the efficacy and safety of LMWH plus mechanical methods for prevention DVT in gynecological cancer patients undergoing major abdominopelivc surgery. The duration of search was from the inception of the databases to March 2021. After literature selection,data extraction and quality assessment was conducted by two reviewers independently;and network Meta-analysis was conducted using Stata 14.0 and RevMan 5.4 software. Results A total of 21 RCTs involving 4,145 patients were included. Network Meta-analysis showed that LMWH plus graduated compression stockings(GCS) or sequential compression devices(SCD)was superior to drug or physical intervention alone in the prevention DVT, and there was no statistically significant difference in the efficacy between LMWH plus GCS or SCD. LMWH had a similar incidence of DVT and major bleeding events compared with unfractionated heparin(UH). Conclusion LMWH plus GCS or SCD was top-ranked for prevention of DVT, for major bleeding events LMWH was similar to UH. The above conclusions are limited by the number and quality of included studies, and need to be verified by more high-quality and multicenter studies.