与活跃癌症相关的静脉血栓栓塞的抗凝固策略进行比较:系统性审查和元分析
Tomohiro Fujisaki1,2, Daisuke Sueta1, Eiichiro Yamamoto1
1Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
JACC. CardioOncology
|March 21, 2024
概括
直接口服抗凝剂 (DOAC) 在与癌症相关的静脉血栓塞栓症 (VTE) 中表现出类似的有效性. 与其他DOAC和亲肠抗凝药相比,阿皮克萨班在没有增加出血风险的情况下提供了潜在的抗血栓益处.
科学领域:
- 血液学 血液学 血液学
- 在瘤学瘤学.
- 药理学 药理学 是一个学科.
背景情况:
- 目前的指导方针建议直接口服抗凝剂 (DOAC) 同样用于管理与癌症相关的静脉血栓栓塞 (VTE).
- 患有VTE的癌症患者需要仔细考虑抗凝药的有效性和安全性.
- 了解DOAC的差异性安全概况对于最佳的患者管理至关重要.
研究的目的:
- 评估DOACs在患有活跃癌症和VTE的患者的比较疗效和安全性.
- 评估不同抗凝策略的复发性VTE,出血事件和复合结果.
- 为了确定DOAC和亲肠道抗凝药之间的安全性概况的潜在差异.
主要方法:
- 17项随机对照试验的网络元分析,涉及6623名活跃癌症患者.
- 在PubMed,Embase和Cochrane Central中进行的搜索截至2022年11月.
- 结果包括复发性VTE,严重出血和临床相关的非重大出血 (CRNMB).
主要成果:
- 在DOAC中没有发现有效性 (复发性VTE,PE,DVT) 的显著差异.
- 阿皮克萨班与达比加特兰和里瓦罗克萨班具有相似的安全性,但与埃多克萨班相比,降低了重大出血风险.
- 艾皮克萨班显示降低了静脉瘤风险与无增加出血的腹腔抗凝药相比;埃多克萨班和里瓦罗克萨班显示出增加了出血风险.
结论:
- DOACs在与癌症相关的静脉瘤治疗中具有相似的疗效,但具有不同的安全性.
- 在这种患者群体中,阿皮克萨班可能会提供抗血栓优势,而不会增加出血风险.
- 阿皮克萨班的安全性特征使其与其他抗凝血策略不同,用于患有静脉血栓炎的癌症患者.
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