摘要
目的通过比较新型口服抗凝剂(NOACs)与传统抗凝剂的优缺点,评价其对需要抗凝治疗的肝硬化患者的疗效与安全性。方法通过计算机检索在PubMed,Embase、Cochrane图书馆、知网、万方、维普等数据库检索相关文献,使用NOS量表对文献进行质量评价,提取数据后使用RevMan5.3软件进行Meta分析。结果共纳入7篇研究,有1篇为随机对照试验,6篇为回顾性队列研究,共3042例患者,其中1677例患者使用了NOACs,1365例患者使用了传统抗凝剂。Meta分析结果显示,与传统抗凝药物组比较,NOACs组具有更低的大出血发生率[OR=0.56,95%CI(0.37~0.85),P<0.01]及更高的血栓再通率[OR=7.77,95%CI(3.48~17.34),P<0.01],差异均有统计学意义。而在全因出血率[OR=0.72,95%CI(0.13~3.91),P=0.07]、全因死亡率[OR=0.72,95%CI(0.25~2.07),P=0.54].复发栓塞和卒中率[OR=0.90,95%CI(0.59~1.39),P=0.64]的比较上,两组差异均无统计学意义。结论NOACs与传统抗凝剂相比,在肝硬化患者治疗中有着较高的安全性和较好的疗效,但国内并未被广泛应用,未来还需要大样本的随机对照试验及前瞻性研究进一步证实。
Objective:To compare the advantages and disadvantages of new oral anticoagulants(NOACS)with traditional anticoagulants,in an attempt to evaluate their efficacy and safety in patients with liver cirrhosis requiring anticoagulant therapy.Methods:Relevant literatures were searched from PubMed,Embase,Cochrane Library,HowNet,Wanfang,VIP and other databases by computer retrieval.The literatures quality was evaluated by NOS.The extracted data were meta-analyzed by RevMan5.3 software.Results:A total of seven studies were included,including one randomized controlled trial and six retrospective cohort studies with a total of 3042 cases.Among them,1677 and 1365 cases used NOACs and traditional anticoagulants.Meta-analysis results showed that compared with the traditional anticoagulant group,the NOACs group had a lower incidence of massive hemorrhage[OR=0.56,95%CI(0.37-0.85),P<0.01]and a higher thrombotic recanalization rate[OR=7.77,95%CI(3.48~17.34),P<0.01],and the difference was statistically significant,while there were no statistically significant differences between thq two groups in comparison to all-cause bleeding rates[OR=0.72,95%CI(0.13-3.91),P=0.07],all-cause mortality[OR=0.72,95%CI(0.25-2.07),P=0.54],recurrent embolism and stroke rates[OR=0.90,95%CI(0.59-1.39),and P=0.64].Conclusion:Compared with traditional anticoagulants,NOACs have higher safety and better efficacy in the treatment of patients with liver cirrhosis,but it has not been widely used in China.Therefore,large-scale randomized controlled trials and prospective studies are further needed to confirm it in the future.
作者
刘天晨
徐华
雷宇
钟珊
周智
Liu Tianchen;Xu Hua;Lei Yu;Zhong Shan;Zhou Zhi(Deparment of Infectious Diseases,the Second Afiliated Hospital of Chongqing Medical University,Chongqing 400010,China;Deparment of Oncology,Chongqing Hospital of Traditional Chinese)
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2022年第6期598-605,共8页
Chinese Journal of Hepatology
关键词
肝硬化
新型口服抗凝剂
传统抗凝剂
META分析
Liver cirrhosis
New oral anticoagulants
Traditional anticoagulants
Meta-analysis