针对癌症患者二次中风预防的抗血栓治疗:系统性审查和网络元分析
Leonardo Zumerkorn Pipek1, Rafaela Farias Vidigal Nascimento2, Sabrina Isabel Coronel3
1Division of Neurology, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil. leonardo.pipek@fm.usp.br.
European journal of clinical pharmacology
|May 7, 2025
概括
癌症患者的中风风险更高. 抗血小板药物对二次中风预防有效,低分子量肝素 (LMWH) 在亚组分析中显示出一致的益处,并且没有增加出血风险.
科学领域:
- 在瘤学瘤学.
- 神经学 神经学
- 药理学 药理学是指药理学的学科.
背景情况:
- 与普通人群相比,癌症患者的中风风险增加了一倍.
- 癌症,化疗,放射治疗和手术都有助于增加中风风险.
- 癌症患者二次中风预防的最佳抗血栓治疗还没有得到很好的定义.
研究的目的:
- 审查各种抗血栓治疗治疗的癌症患者中风复发情况.
- 评估与不同抗血栓治疗相关的出血风险.
- 为了比较抗血小板剂,华法林,肝素和直接口服抗凝剂的疗效.
主要方法:
- 系统的文献审查遵循PRISMA指南.
- 来自PubMed,Embase和Scopus的11项研究 (1319名患者) 的网络元分析.
- 基于D-二次元水平,中风区域和研究偏差的亚组分析.
主要成果:
- 抗血小板药物在减少中风复发方面排名最高 (RR 0.44 [0.20; 0.96]).
- 低分子量肝素 (LMWH) 也显著减少了复发 (RR 0.50 [0.26; 0.96]),并在子组分析中排名更高.
- 两种疗法之间在重大出血或死亡率方面没有发现显著差异.
结论:
- 抗血小板药是一种可行的选择,用于癌症患者的二次中风预防,特别是那些出血风险较高的人.
- 在各个子组分析中,LMWH表现出一致的好处.
- 需要进一步进行高质量的研究,以确定特定的患者亚组,这些患者最受益于特定的抗血栓剂.
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