Treatment of venous thromboembolism in patients with cancer: A network meta-analysis comparing efficacy and safety of anticoagulants.
Treatment of venous thromboembolism in patients with cancer: A network meta-analysis comparing efficacy and safety of anticoagulants.
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DOI：
10.1016/j.thromres.2015.07.011
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发表时间：
2015-09
影响因子：
7.5
通讯作者：
Ay C
中科院分区：
文献类型：
--
作者：
Posch F;Königsbrügge O;Zielinski C;Pabinger I;Ay C
低分子量肝素（LMWH）和维生素K拮抗剂（VKA）是目前癌症患者急性静脉血栓栓塞（VTE）的治疗选择。直接作用口服抗凝剂（DOAC）在治疗癌症患者VTE中的作用，特别是与当前标准治疗（LMWH）相比，仍不清楚。在这项网络荟萃分析中，我们比较了LMWH、VKA和DOAC治疗癌症相关VTE的相对疗效和安全性。一项预先指定的检索方案确定了10项随机对照试验，包括3242例癌症患者。使用随机效应荟萃回归模型分析复发性VTE（疗效）和大出血（安全性）的相对风险（RR）。LMWH在降低复发性VTE风险方面明显上级VKA（RR=0.60，95%CI：0.45-0.79，p<0.001），其安全性与VKA相当（RR=1.08，95%CI：0.70-1.66，p=0.74）。对于DOAC与VKA的疗效和安全性比较，相对风险估计值支持DOAC，但置信区间仍包括等效性（复发性VTE的RR =0.65，95%CI：0.38-1.09，p=0.10;大出血的RR =0.72，95%CI：0.39-1.37，p=0.32）。在DOAC和LMWH之间的间接网络比较中，结果表明疗效相当（RR=1.08，95%CI：0.59-1.95，p=0.81），DOAC安全性改善的相对风险不显著（RR=0.67，95%CI：0.31-1.46，p=0.31）。在调整LMWH与VKA和DOAC与VKA研究之间复发性VTE和大出血的不同风险后，结果占优势。LMWH和DOAC治疗癌症患者VTE的疗效和安全性可能相当。
Low-molecular-weight heparin (LMWH) and vitamin K antagonists (VKA) are current treatment options for cancer patients suffering from acute venous thromboembolism (VTE). The role of direct-acting oral anticoagulants (DOACs) for the treatment of VTE in cancer patients, particular in comparison with the current standard of care which is LMWH, remains unclear. In this network meta-analysis, we compared the relative efficacy and safety of LMWH, VKA, and DOAC for the treatment of cancer-associated VTE. A pre-specified search protocol identified 10 randomized controlled trials including 3242 cancer patients. Relative risks (RR) of recurrent VTE (efficacy) and major bleeding (safety) were analyzed using a random-effects meta-regression model. LMWH emerged as significantly superior to VKA with respect to risk reduction of recurrent VTE (RR=0.60, 95%CI:0.45-0.79, p<0.001), and its safety was comparable to VKA (RR=1.08, 95%CI:0.70-1.66, p=0.74). For the DOAC vs. VKA efficacy and safety comparison, the relative risk estimates were in favor of DOAC, but had confidence intervals that still included equivalence (RR for recurrent VTE=0.65, 95%CI:0.38-1.09, p=0.10; RR for major bleeding=0.72, 95%CI:0.39-1.37, p=0.32). In the indirect network comparison between DOAC and LMWH, the results indicated comparable efficacy (RR=1.08, 95%CI:0.59-1.95, p=0.81), and a non-significant relative risk towards improved safety with DOAC (RR=0.67, 95%CI:0.31-1.46, p=0.31). The results prevailed after adjusting for different risk of recurrent VTE and major bleeding between LMWH vs. VKA and DOAC vs. VKA studies. The efficacy and safety of LMWH and DOACs for the treatment of VTE in cancer patients may be comparable.
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影响因子：
45.3
作者：
Lyman, Gary H.;Khorana, Alok A.;Falanga, Anna
通讯作者：
Falanga, Anna
影响因子：
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作者：
Hull, Russell D.;Pineo, Graham F.;Raskob, Gary
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影响因子：
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作者：
Prins, Martin H.;Lensing, Anthonie W. A.;Prandoni, Paolo
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影响因子：
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作者：
Mills, Edward J.;Thorlund, Kristian;Ioannidis, John P. A.
通讯作者：
Ioannidis, John P. A.
DOI：
10.1016/j.ejvs.2008.11.030
发表时间：
2009-03-01
影响因子：
5.7
作者：
Romera, A.;Cairols, M. A.;Lapiedra, O.
通讯作者：
Lapiedra, O.