新型口服抗凝药治疗病态肥胖或高体重静脉血栓栓塞患者的有效性及安全性Meta分析

Efficacy and Safety of Novel Oral Anticoagulant for Venous Thromboembolism Therapy in Patients With Morbid Obesity or High Body Weight:a Meta-analysis

目的:评价新型口服抗凝药(NOAC)与维生素K拮抗剂(VKA)治疗病态肥胖(体重指数>40 kg/m^(2))或高体重(>120 kg)静脉血栓栓塞(VTE)患者的有效性及安全性。方法:检索从2000年1月到2022年5月在中国生物医学文献数据库、中国知网、维普网、万方数据库、PubMed、Embase、Cochrane图书馆、Web of Science的相关文献,依据纳入标准及排除标准筛选文献并进行质量评价,结局指标包括VTE发生率、大出血发生率。应用Review Manager 5.3进行异质性检验及Meta分析。结果:共纳入13篇文献,共14648例患者,NOAC组6188例,VKA组8460例。Meta分析结果表明,与VKA相比,NOAC的VTE发生风险(OR=0.62,95%CI:0.51~0.76,I^(2)=0%,P<0.00001)及大出血发生风险(OR=0.77,95%CI:0.60~1.00,I^(2)=0%,P=0.05)均降低。结论:与VKA相比,NOAC用于病态肥胖或高体重的VTE患者更有效、安全。

Objectives:To evaluate the efficacy and safety of novel oral anticoagulant(NOAC)and vitamin K antagonist(VKA)in the treatment of venous thromboembolism(VTE)in patients with morbid obesity(body mass index[BMI]>40 kg/m^(2))or high body weight(>120 kg).Methods:The related literature published from January 2000 to May 2022 was searched from China Biology Medicine(CBM),China National Knowledge Infrastructure(CNKI),VIP,Wanfang database,PubMed,Embase,the Cochrane Library,Web of Science.The literature was screened according to inclusion and exclusion criteria,and the quality of the included literature was evaluated.The outcome measures included the incidence of VTE and incidence of major bleeding.Review Manager 5.3 software was used for the meta-analysis.Results:Thirteen studies were included with a total of 14648 patients.Among them,6188 patients received NOAC treatment,8640 patients received VKA treatment.The results of the meta-analysis showed that the risk of VTE(OR=0.62,95%CI:0.51-0.76,I^(2)=0%,P<0.00001)and the risk of major bleeding(OR=0.77,95%CI:0.60-1.00,I^(2)=0%,P=0.05)were both lower post NOAC treatment than post VKA treatment in patients with morbid obesity or high body weight.Conclusions:NOAC is more effective and safer than VKA in the treatment of VTE in patients with morbid obesity or high body weight.