Efficacy and safety of anticoagulants for postoperative thrombophylaxis in total hip and knee arthroplasty: A PRISMA-compliant Bayesian network meta-analysis.
Efficacy and safety of anticoagulants for postoperative thrombophylaxis in total hip and knee arthroplasty: A PRISMA-compliant Bayesian network meta-analysis.
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DOI：
10.1371/journal.pone.0250096
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Zhu J
中科院分区：
文献类型：
--
作者：
He T;Han F;Wang J;Hu Y;Zhu J
从THA和TKA的随机临床试验（rct）中寻找、回顾和分析各种抗凝剂的疗效和安全性。符合prisma标准的贝叶斯网络元分析。截至2017年3月，我们检索了The Medline、Embase、ClinicalTrial和Cochrane Library数据库，以寻找接受THA或TKA患者的随机对照试验。主要疗效指标是静脉血栓栓塞的优势比（OR）。安全性指标为大出血或临床相关出血的优势比。计算95%可信区间OR （95% cris）。当95%CrIs排除空值时，结果被解释为关联。35项随机对照试验（53787例患者，平均年龄范围，大多为55-70岁，平均体重范围，大多为55-90 kg，女性平均比例高于男性，约为60%）包括以下抗凝血药物类别：氟达达帕里诺、依多沙班、利伐沙班、阿哌沙班、达比加群、低分子肝素、ximelagatran、阿司匹林、华法林。抗凝剂的有效性排名依次为：fondaparinux（88.89%±10.90%）、依多沙班（85.87%±13.34%）、利伐沙班（86.08%±10.23%）、阿哌沙班（68.26%±10.82%）、达比加群（41.63%±12.26%）、低分子肝素（41.03%±9.60%）、ximelagatran（37.81%±15.87%）、阿司匹林（35.62%±20.60%）、华法林（9.89%±9.07%）、安慰剂（4.56%±6.37%）。临床相关出血事件排名依次为：氟达帕苷（14.53%±15.25%）、昔美加群（18.93%±17.49%）、利伐沙班（23.86%±15.14%）、达比加群（28.30%±14.18%）、依多沙班（38.76%±24.25%）、低分子肝素（53.28%±8.40%）、阿哌沙班（71.81%±10.92%）、安慰剂（76.26%±14.61%）、阿司匹林（86.32%±25.74%）、华法林（87.95%±11.27%）。试验间未观察到统计学上显著的异质性。根据我们的结果，所有抗凝药物对静脉血栓栓塞的预防都有一定的效果。我们的排名表明，对于THA或TKA患者，fondaparinux和利伐沙班比其他抗凝药物更安全、更有效。
To search, review, and analyze the efficacy and safety of various anticoagulants from randomized clinical trials (RCTs) of anticoagulants for THA and TKA. PRISMA-compliant Bayesian Network Meta-analysis. The databases of The Medline, Embase, ClinicalTrial, and Cochrane Library databases were searched until March 2017 for RCTs of patients undergoing a THA or TKA. The primary efficacy measurement was the venous thromboembolism Odds ratio (OR). The safety measurement was the odds ratio of major or clinically relevant bleeding. OR with 95% credibility intervals (95%CrIs) were calculated. Findings were interpreted as associations when the 95%CrIs excluded the null value. Thirty-five RCTs (53787 patients; mean age range, mostly 55–70 years; mean weight range, mostly 55–90 kg; and a higher mean proportion of women than men, around 60%) included the following Anticoagulants categories: fondaparinux, edoxaban, rivaroxaban, apixaban, dabigatran, low-molecular-weight heparin, ximelagatran, aspirin, warfarin. Anticoagulants were ranked for effectiveness as follows: fondaparinux (88.89% ± 10.90%), edoxaban (85.87% ± 13.34%), rivaroxaban (86.08% ± 10.23%), apixaban (68.26% ± 10.82%), dabigatran (41.63% ± 12.26%), low-molecular-weight heparin (41.03% ± 9.60%), ximelagatran (37.81% ± 15.87%), aspirin (35.62% ± 20.60%), warfarin (9.89% ± 9.07%), and placebo (4.56% ± 6.37%). Ranking based on clinically relevant bleeding events was as follows: fondaparinux (14.53% ± 15.25%), ximelagatran (18.93% ± 17.49%), rivaroxaban (23.86% ± 15.14%), dabigatran (28.30% ± 14.18%), edoxaban (38.76% ± 24.25%), low-molecular-weight heparin (53.28% ± 8.40%), apixaban (71.81% ± 10.92%), placebo (76.26% ± 14.61%), aspirin (86.32% ± 25.74%), and warfarin (87.95% ± 11.27%). No statistically significant heterogeneity was observed between trials. According to our results, all anticoagulant drugs showed some effectiveness for VTE prophylaxis. Our ranking indicated that fondaparinux and rivaroxaban were safer and more effective than other anticoagulant drugs for patients undergoing THA or TKA.
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影响因子：
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作者：
Hull, RD;Pineo, GF;Brant, R
通讯作者：
Brant, R
影响因子：
37.8
作者：
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通讯作者：
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作者：
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