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对中期至高风险肺栓塞的干预措施的比较:一个网络的元分析
Yoshiko Ishisaka1, Atsuyuki Watanabe2, Tomohiro Fujisaki3
1Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA.
概括
与其他治疗方法相比,导管治疗 (CDT) 对中等至高风险肺栓塞 (PE) 患者的死亡率结果有所改善. 这项研究发现CDT有效,但不显著增加出血风险.
科学领域:
- 心脏病学 心脏病学
- 肺部医学 肺部医学
- 干预性放射学 干预性放射学
背景情况:
- 肺栓塞 (PE) 具有重大风险,可用各种治疗方法.
- 目前中等至高危PE的治疗选择包括导管治疗 (CDT),全身血栓溶解 (ST),外科栓塞切除 (SE) 和抗凝 (AC).
- 这些干预措施的相对有效性和安全性仍然不清楚.
研究的目的:
- 进行网络元分析,比较CDT,ST,SE和AC的有效性和安全性,用于中等至高风险PE.
- 评估住院死亡率和重大出血的主要结局.
- 评估二次结果,包括长期死亡率,复发性PE,轻微出血和内出血.
主要方法:
- 在2023年1月进行了PubMed和EMBASE的系统文献搜索.
- 网络对11项RCT和42项观察性研究的元分析,涉及157,454名中等或高风险PE患者.
- 对AC,CDT,SE和ST进行比较,分析住院死亡率,重大出血,长期死亡率,复发性PE,轻微出血和内出血.
主要成果:
- 与系统性血栓溶解 (ST),抗凝血 (AC) 和手术栓塞术 (SE) 相比,导导管治疗 (CDT) 与医院内死亡率显著降低.
- 与ST和AC相比,CDT显示复发性肺栓塞 (PE) 的发生率较低,而且比SE的发生率更低.
- 与CDT和AC相比,系统性血栓溶解 (ST) 显示出较高的重大出血风险.
结论:
- 导管治疗 (CDT) 与中期至高风险肺栓塞 (PE) 患者的死亡率改善有关.
- 与其他干预措施相比,CDT在出血风险方面提供了有利的安全概况.
- 排列图分析表明CDT是减少住院死亡率,长期死亡率和复发性PE的主要干预措施.
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