利伐沙班致亚洲患者出血危险因素Meta分析

Risk Factors of Bleeding Induced by Rivaroxaban in Asian Patients:A Meta-Analysis

目的探讨利伐沙班致亚洲患者出血的影响因素。方法检索PubMed、Medline、The Cochrane Library、中国知网、维普、万方、中国生物医学文献数据库中利伐沙班致亚洲患者出血不良反应影响因素相关文献,检索时限为各数据库自建库起至2022年12月31日。采用RevMan 5.4统计学软件进行Meta分析。结果共纳入12篇文献,涉及18211例患者。性别为男性[OR=2.02,95%CI(1.59,2.57),P<0.01],既往出血史[OR=3.41,95%CI(1.84,6.35),P<0.01],肌酐清除率(CCr)<50 mL/min[OR=2.29,95%CI(1.77,2.95),P<0.01],使用双联抗血小板药物[阿司匹林+氯吡格雷;OR=2.15,95%CI(1.69,2.74),P<0.01],使用非甾体抗炎药[OR=3.06,95%CI(1.87,45.00),P<0.01],CHA_(2)DS_(2)-VASc评分>4分[OR=1.65,95%CI(1.29,2.13),P<0.01],凝血酶原时间(PT)>13 s[OR=3.01,95%CI(1.82,4.99),P<0.01],以及利伐沙班日剂量≥20 mg[OR=2.59,95%CI(1.82,3.70),P<0.01]是利伐沙班致亚洲患者出血不良反应的危险因素(P<0.01)。结论临床医护人员应关注有既往出血史、PT>13 s、CCr<50 mL/min、使用双联抗血小板药物、CHA_(2)DS_(2)-VASc评分>4分的男性患者,并尽量小剂量(<20 mg)用药,警惕大出血的发生。

Objective To investigate the influencing factors of bleeding induced by rivaroxaban in Asian patients.Methods The studies related to the influencing factors of bleeding induced by rivaroxaban in Asian patients in the PubMed,Medline,The Cochrane Library,CNKI,VIP,WanFang and CBM from the inception of each database to December 31,2022 were searched.The RevMan 5.4 statistical software was used for Meta-analysis.Results A total of 12 studies were included,involving 18211 patients.Male[OR=2.02,95%CI(1.59,2.57),P<0.01],history of bleeding[OR=3.41,95%CI(1.84,6.35),P<0.01],creatinine clearance rate(CCr)<50 mL/min[OR=2.29,95%CI(1.77,2.95),P<0.01],use of dual antiplatelet drugs[aspirin+clopidogrel;OR=2.15,95%CI(1.69,2.74),P<0.01],use of nonsteroidal anti-inflammatory drugs[OR=3.06,95%CI(1.87,45.00),P<0.01],CHA_(2)DS_(2)-VASc score>four points[OR=1.65,95%CI(1.29,2.13),P<0.01],prothrombin time(PT)>13 s[OR=3.01,95%CI(1.82,4.99),P<0.01],and daily dose of rivaroxaban≥20 mg[OR=2.59,95%CI(1.82,3.70),P<0.01]were the risk factors of bleeding induced by rivaroxaban in Asian patients(P<0.01).Conclusion Clinical medical staff should pay attention to the male patients with a history of bleeding,PT>13 s,CCr<50 mL/min,use of dual antiplatelet drugs,and CHA_(2)DS_(2)-VASc score>four points,give drugs at a small dose(<20 mg)as much as possible,and be alert to the occurrence of haemorrhages.