抗凝药物预防PICC导管相关性血栓形成的Meta分析

Meta-analysis of Anticoagulant Drugs for Prevention of PICC Catheter-related Thrombosis

目的评价使用抗凝药物预防PICC-CRT的有效性及安全性,不同抗凝药物预防效果的优劣,为预防置管后PICC-CRT形成提供参考。方法使用计算机检索2010-2022年PubMed、EMbase、Cochrane Library、Web of Science、Ovid、EBSCO、Elsevier、Wiley、中国学术期刊全文数据库、中国生物医学文摘数据库和万方数据库中有关抗凝药物预防PICC-CRT效果的随机对照试验。按照纳入、排除标准进行文献筛选,根据Cochrane Handbook偏倚风险工具对纳入文献进行质量评价。采用RevMan 5.3软件进行Meta分析。利用Stata软件进行网状Meta分析。结果最终纳入8个RCTs,共1493例PICC置管患者。Meta分析显示,预防性使用抗凝药物可有效减少PICC置管患者导管相关性血栓发生率[OR=0.22,95%CI(0.13,0.36),P<0.01],对血小板、D-二聚体影响不明显,差异无统计学意义,OR值分别为[OR=-3.25,95%CI(-12.04,5.54),P>0.01]、[OR=-0.02,95%CI(-0.04,0.00),P>0.01]。抗凝药物带来的药物不良反应较少,差异无统计学意义[OR=1.83,95%CI(0.38,8.68),P>0.01]。网状Meta分析显示:低分子肝素钠对PICC置管患者的血栓发生率的改善效果最佳,其次是低分子肝素钙、阿司匹林、利伐沙班。结论抗凝药物可有效预防PICC-CRT,对PICC相关性血栓发生的高危人群推荐优先使用低分子肝素钠进行预防性抗凝。同时密切监测药物不良反应及血常规、凝血功能的变化。

Objective To evaluate the efficacy and safety of anticoagulants in preventing PICC-CRT,and the preventive effects of different anticoagulants,so as to provide reference for preventing the formation of PICC-CRT after catheterization.Methods PubMed,EMbase,Cochrane Library,Web of Science,Ovid,EBSCO,Elsevier,Wiley,China Academic Journal Full-text Database,China Biomedical Abstracts Database and Wanfang Database were searched by computer for randomized controlled trials on the effect of anticoagulant drugs in preventing PICC-CRT from 2010 to 2022.The literature was screened according to the inclusion and exclusion criteria,and the quality of the included literature was evaluated according to the Cochrane Handbook bias risk tool.Meta-analysis was performed using RevMan 5.3 software.Network meta-analysis was performed using Stata software.Results Finally,8 RCTs were included,involving 1493 patients with PICC catheterization.Meta-analysis showed that prophylactic use of anticoagulants could effectively reduce the incidence of catheter-related thrombosis in patients with PICC[OR=0.22,95%CI(0.13,0.36),P<0.01],there was no significant effect on platelet and D-dimer,and the difference was not statistically significant,the OR values were[OR=-3.25,95%CI(-12.04,5.54),P>0.01],[OR=-0.02,95%CI(-0.04,0.00),P>0.01],respectively.The adverse drug reactions caused by anticoagulant drugs were less,and the difference was not statistically significant[OR=1.83,95%CI(0.38,8.68),P>0.01].Network Meta-analysis showed that low molecular weight heparin sodium had the best effect on improving the incidence of thrombosis in patients with PICC catheterization,followed by low molecular weight heparin calcium,aspirin and rivaroxaban.Conclusion Anticoagulant drugs can effectively prevent PICC-CRT.Low molecular weight heparin sodium is recommended to prevent PICC-related thrombosis in high risk population.At the same time,the changes of adverse drug reactions,blood routine and coagulation function are closely monitored.