直接口服抗凝剂度与临床结果之间的关联:系统性审查和元分析
Brandon Stretton1,2,3, Philip Harford1, Joshua Kovoor1,2,3
1Adelaide Medical School, Faculty of Health and Medical Science, University of Adelaide, South Australia, Australia.
Surgery in practice and science
|January 23, 2025
概括
直接口服抗凝剂 (DOAC) 水平显示没有与出血或栓塞风险的显著联系. 需要进一步的研究来确定安全的,针对患者的DOAC测定度,用于术后护理.
科学领域:
- 药理学和治疗学 药理学和治疗学
- 心血管医学 心血管医学
- 血液学 血液学 血液学
背景情况:
- 目前的指导方针建议术前直接口服抗凝剂 (DOAC) 水平低于30-50ng/ml,但证据有限.
- 了解DOAC测定位和临床结果之间的关系对于指导术后管理至关重要.
- 本次审查解决了对DOAC监测的基于证据的参考范围的需求.
研究的目的:
- 为了确定DOAC的血度是否与出血或全身血栓事件相关.
- 评估DOAC测定标位与在外科手术期间患者安全之间的关联.
- 为DOAC监测制定治疗性或危险性参考范围提供信息.
主要方法:
- 使用同行评审的搜索策略进行了系统的文献搜索.
- 包括专注于对心房或静脉血栓栓塞的DOAC治疗的研究.
- 通过叙述和元分析合成数据,包括对DOAC水平和临床事件的元回归,遵守PRISMA指南.
主要成果:
- 系统性审查包括了17项研究,其中14项有助于元分析.
- 在DOAC测定度和增加的出血或全身栓塞事件之间没有发现显著的关系.
- 超回归表明,DOAC低谷或高峰水平的增加与出血或栓塞事件的发生率之间没有统计学上显著的关联.
结论:
- 单变元元回归显示DOAC测定度与患者出血或全身栓塞风险之间没有显著的独立关系.
- 这些发现表明,患者特异的DOAC测定度可以用于适当的抗凝剂,如果超出该度,风险可能不会增加.
- 需要进一步的研究来描述这些潜在的绝对度及其在外科手术环境中的有用性.
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