中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2013年
10期
960-965
,共6页
王建民%曹立颖%杨声坪%姜明静%王冠
王建民%曹立穎%楊聲坪%薑明靜%王冠
왕건민%조립영%양성평%강명정%왕관
静脉血栓栓塞%关节成形术,置换,髋%Meta分析%依诺肝素%阿哌沙班
靜脈血栓栓塞%關節成形術,置換,髖%Meta分析%依諾肝素%阿哌沙班
정맥혈전전새%관절성형술,치환,관%Meta분석%의낙간소%아고사반
Venous thromboembolism%Arthroplasty,replacement,hip,knee%Meta-analysis%Enoxaparin%Apixaban
目的 系统评价阿哌沙班与依诺肝素预防骨科大手术后静脉血栓栓塞(venous thromboembolism,VTE)的有效性和安全性. 方法 应用Cochrane系统评价方法计算机检索Cochrane Library、PubMed 、EMBASE、中国生物医学文献数据库、中国期刊全文数据库和维普数据库,并手工检索相关领域杂志.检索不受语种限制,时间均从建库至2012年3月,收集阿哌沙班与依诺肝素比较预防骨科大手术后VTE的所有随机对照试验.根据Cochrane协作网推荐的“风险评估工具”进行偏倚风险评估,用RevMan 5.1软件进行统计学分析. 结果 最终纳入4个随机对照试验,共12 897例患者.阿哌沙班与依诺肝素比较,总的VTE和各种原因所致的死亡[相对危险度(RR)=0.63,95％可信区间(CI)0.41,0.96]、主要VTE(RR =0.59,95％ CI0.19,0.98)、症状性深静脉血栓(RR =0.50,95％ CI0.26,0.97)等方面差异有统计学意义,在致死性肺栓塞方面差异无统计学意义(RR=1.57,95％ CI0.41,5.99).对于全膝关节置换患者,阿哌沙班组在严重出血事件(RR =0.55,95％ CI0.32,0.96)、总的出血事件(RR =0.79,95％ CI 0.66,0.95)发生率上低于依诺肝素组,而对于全髋关节置换患者,两组之间差异无统计学意义.药物相关严重不良事件发生率,两者差异无统计学意义(RR =0.97,95％ CI 0.59,1.58). 结论 阿哌沙班预防骨科大手术后VTE的疗效肯定,能显著降低术后VTE的风险.
目的 繫統評價阿哌沙班與依諾肝素預防骨科大手術後靜脈血栓栓塞(venous thromboembolism,VTE)的有效性和安全性. 方法 應用Cochrane繫統評價方法計算機檢索Cochrane Library、PubMed 、EMBASE、中國生物醫學文獻數據庫、中國期刊全文數據庫和維普數據庫,併手工檢索相關領域雜誌.檢索不受語種限製,時間均從建庫至2012年3月,收集阿哌沙班與依諾肝素比較預防骨科大手術後VTE的所有隨機對照試驗.根據Cochrane協作網推薦的“風險評估工具”進行偏倚風險評估,用RevMan 5.1軟件進行統計學分析. 結果 最終納入4箇隨機對照試驗,共12 897例患者.阿哌沙班與依諾肝素比較,總的VTE和各種原因所緻的死亡[相對危險度(RR)=0.63,95％可信區間(CI)0.41,0.96]、主要VTE(RR =0.59,95％ CI0.19,0.98)、癥狀性深靜脈血栓(RR =0.50,95％ CI0.26,0.97)等方麵差異有統計學意義,在緻死性肺栓塞方麵差異無統計學意義(RR=1.57,95％ CI0.41,5.99).對于全膝關節置換患者,阿哌沙班組在嚴重齣血事件(RR =0.55,95％ CI0.32,0.96)、總的齣血事件(RR =0.79,95％ CI 0.66,0.95)髮生率上低于依諾肝素組,而對于全髖關節置換患者,兩組之間差異無統計學意義.藥物相關嚴重不良事件髮生率,兩者差異無統計學意義(RR =0.97,95％ CI 0.59,1.58). 結論 阿哌沙班預防骨科大手術後VTE的療效肯定,能顯著降低術後VTE的風險.
목적 계통평개아고사반여의낙간소예방골과대수술후정맥혈전전새(venous thromboembolism,VTE)적유효성화안전성. 방법 응용Cochrane계통평개방법계산궤검색Cochrane Library、PubMed 、EMBASE、중국생물의학문헌수거고、중국기간전문수거고화유보수거고,병수공검색상관영역잡지.검색불수어충한제,시간균종건고지2012년3월,수집아고사반여의낙간소비교예방골과대수술후VTE적소유수궤대조시험.근거Cochrane협작망추천적“풍험평고공구”진행편의풍험평고,용RevMan 5.1연건진행통계학분석. 결과 최종납입4개수궤대조시험,공12 897례환자.아고사반여의낙간소비교,총적VTE화각충원인소치적사망[상대위험도(RR)=0.63,95％가신구간(CI)0.41,0.96]、주요VTE(RR =0.59,95％ CI0.19,0.98)、증상성심정맥혈전(RR =0.50,95％ CI0.26,0.97)등방면차이유통계학의의,재치사성폐전새방면차이무통계학의의(RR=1.57,95％ CI0.41,5.99).대우전슬관절치환환자,아고사반조재엄중출혈사건(RR =0.55,95％ CI0.32,0.96)、총적출혈사건(RR =0.79,95％ CI 0.66,0.95)발생솔상저우의낙간소조,이대우전관관절치환환자,량조지간차이무통계학의의.약물상관엄중불량사건발생솔,량자차이무통계학의의(RR =0.97,95％ CI 0.59,1.58). 결론 아고사반예방골과대수술후VTE적료효긍정,능현저강저술후VTE적풍험.
Objective To systematically assess the clinical efficacy and safety of apixaban versus enoxaparin in the prevention of venous thromboembolism (VTE) after major orthopedic surgery.Methods Based on the principles and methods of Cochrane systematic review,the Cochrane Library,PubMed,EMBASE,Chinese Bio-medicine Database,China Journal Full-text Database,VIP Database were searched from their establishment to March 2012 in whatever languages.Related journals were handsearched as well.Randomized controlled trials (RCTs) of comparing apixaban and enoxaparin in the prevention of venous thromboembolism after major orthopedic operation were included.Cochrane Collaboration' s tool was used for assessing risk of bias in the included trials.Cochrane Collaboration' s software RevMan 5.1 was used for statistical analysis.Results Four RCTs totaling 12 897 patients were included.Apixaban treatment showed significant differences in aspects of total VTE and all-cause mortality [relative risk (RR) =0.63,95％ CI(0.41,0.96)],major VTE [RR =0.59,95％ CI(0.19,0.98)] and symptomatic deep vein thrombosis (DVT) [RR =0.50,95％ CI(0.26,0.97)] when compared with enoxaparin,but the difference in fatal pulmonary embolism was insignificant[RR =1.57,95％ CI(0.41,5.99)].For patients undergoing total knee arthroplasty,apixaban was associated with significantly fewer major bleeding events[RR =0.55,95％ CI(0.32,0.96)] and fewer total bleeding events[RR =0.79,95％ CI(0.66,0.95)] than enoxaparin.For patients undergoing total hip replacement,however,the two treatments revealed no statistically significant differences.With regard to the incidence of drug-related serious adverse events,the two treatments displayed no significant difference[RR =0.97,95％ CI(0.59,1.58)].Conclusion Apixaban is effective in the prevention of VTE after major orthopedic surgery and can significantly reduce the risk of postoperative VTE.
