骨折后血栓预防剂的有效性:系统性审查和网络元分析
Ahmed M Negm1, Lisa Yamaura1, Ashley Clarke1
1Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
JB & JS open access
|November 8, 2023
概括
在骨骨折手术中,没有单一的血栓预防药物在减少静脉血栓塞栓症 (VTE) 或出血方面表现出优越性. 需要进一步进行高质量的试验,以确定这些患者的最佳预防策略.
科学领域:
- 整形外科手术 整形外科手术
- 药理学 药理学 是一个学科.
- 基于证据的医学 基于证据的医学
背景情况:
- 部骨折手术患者经常接受药理性血栓预防治疗.
- 药剂包括阿司匹林,肝素,直接口服抗凝剂 (DOAC) 和华法林.
- 由于缺乏比较有效性数据,临床实践存在差异.
研究的目的:
- 进行系统审查和网络元分析 (NMA).
- 为了比较不同血栓预防药物的有效性.
- 在接受关节骨折手术的患者中减少静脉血栓塞栓症 (VTE).
主要方法:
- 在Embase,MEDLINE和CENTRAL数据库中进行系统搜索 (2000年1月至2022年2月).
- 包括19项研究,包括49,409名参与者,用于VTE结局.
- 贝叶斯的NMA曾经通过SUCRA将赔率比率和干预排名放在一起.
主要成果:
- 在阿司匹林,UFH,LMWH,DOAC和华法林之间,VTE或出血率没有统计学上显著的差异.
- 在19项纳入的研究中,有15项具有高偏差风险.
- NMA包括6次对VTE进行血栓预防干预,3次用于出血.
结论:
- 目前的血栓预防药物在关节骨折患者的疗效或安全性上没有显著差异.
- 需要更多高质量的随机对照试验.
- 最佳的血栓预防策略需要进一步研究.
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