静脉血栓患者口服抗凝治疗有效性和安全性的评价

Review of the efficacy and safety of oral anticoagulants in patients with venous thrombosis

目的评价药学监护模式对静脉血栓栓塞(venous thromboembolism,VTE)患者口服抗凝药(oral anticoagulants,OACs)治疗的有效性和安全性。方法检索Cochrane Library、EmBase、PubMed、MedLine、Ebsco、ProQuest、中国知网、维普和万方等数据库,检索时限为自建库至2020-09-30。试验组干预方式为不同模式的药学监护及随访;对照组无干预,仅进行常规医疗随访。用Revman 5.4.1对随机对照研究(randomized controlled trials,RCTs)进行Meta分析,对无法进行Meta分析的资料和队列研究进行描述性分析。结果共纳入RCTs研究11项,队列研究3项;患者共1828例。Meta分析结果显示:试验组和对照组的再栓塞事件发生率分别为1.28%和6.14%,出血事件发生率分别为8.45%和19.18%,国际标准化比值达标率分别为72.43%和36.27%,完全依从性分别为79.34%和56.20%,差异均有统计学意义(P<0.05,P<0.001)。结论药学监护可以显著降低患者再栓塞事件发生率和出血事件发生率等,并有效提高患者用药依从性和复诊率。

Objective To evaluate the efficacy and safety of oral anticoagulants(OACs)in patients with venous thrombosis embolism(VTE)under different pharmaceutical care model.Methods Cochrane Library,EmBase,PubMed,MedLine,Ebsco,ProQuest,CNKI,VIP,and WanFang data were researched from inception to September 30,2020.Patients were divided into treatment group(different pharmaceutical care model)and control group(routine medical follow-up)according to whether received pharmaceutical care.Meta analysis of randomized controlled trials(RCTs)were carried out with software Revman 5.4.1.A descriptive analysis for cohort studies was conducted.Results A total of 11 RCTs and 3 cohort studies conformed to the inclusion criteria,which included 1828 patients.The Meta analysis results showed that the incidences of thrombotic events in the treatment and control groups were 1.28%and 6.14%;the incidences of bleeding events were 8.45%and 19.18%;the standard rates of international normalized ratios were 72.43%and 36.27%;the medication compliance rates of patients were 79.34%and 56.20%.The differences were statistically significant(P<0.05,P<0.001).Conclusion Pharmaceutical care can significantly reduce the incidence of thrombotic and bleeding events,and effectively improve the compliance and the rate of return visit.