PDF(Pubmed)
Abstract：
Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in cancer patients. Low molecular weight heparin (LMWH) has been the standard of care but new guidelines have approved the use of non-vitamin K antagonist oral anticoagulants (NOAC). By conducting an individual patient data (IPD) meta-analysis of randomised controlled trials (RCTs) comparing the outcomes of NOAC versus LMWH in cancer patients, we aim to determine an ideal strategy for the prophylaxis of VTE and prevention of VTE recurrence. Three databases were searched from inception until 19 October 2022. IPD was reconstructed from Kaplan-Meier curves. Shared frailty, stratified Cox and Royston-Parmar models were fit to compare the outcomes of venous thromboembolism recurrence and major bleeding. For studies without Kaplan-Meier curves, aggregate data meta-analysis was conducted using random-effects models. Eleven RCTs involving 4844 patients were included. Aggregate data meta-analysis showed that administering NOACs led to a significantly lower risk of recurrent VTE (RR = 0.65; 95%CI: 0.50-0.84) and deep vein thrombosis (DVT) (RR = 0.60; 95%CI: 0.40-0.90). In the IPD meta-analysis, NOAC when compared with LMWH has an HR of 0.65 (95%CI: 0.49-0.86) for VTE recurrence. Stratified Cox and Royston-Parmar models demonstrated similar results. In reducing risks of recurrent VTE and DVT among cancer patients, NOACs are superior to LMWHs without increased major bleeding.
摘要：
静脉血栓栓塞（VTE）是癌症患者发病和死亡的主要原因。低分子量肝素（LMWH）已成为护理标准，但新指南已批准使用非维生素K拮抗剂口服抗凝剂（NOAC）。通过对随机对照试验（RCT）进行个体患者数据（IPD）荟萃分析，比较NOAC与LMWH在癌症患者中的结果，我们旨在确定预防VTE和预防VTE复发的理想策略.从开始到2022年10月19日搜索了三个数据库。从Kaplan-Meier曲线重建IPD。共同的脆弱，采用Cox和Royston-Parmar分层模型比较静脉血栓栓塞复发和大出血的结局.对于没有卡普兰-迈耶曲线的研究，使用随机效应模型进行汇总数据荟萃分析.包括11个RCTs，涉及4844例患者。综合数据荟萃分析显示，使用NOAC可显著降低复发性VTE（RR=0.65；95CI：0.50-0.84）和深静脉血栓形成（DVT）（RR=0.60；95CI：0.40-0.90）的风险。在IPD荟萃分析中，与LMWH相比，NOAC的VTE复发HR为0.65（95CI：0.49-0.86）。分层的Cox和Royston-Parmar模型显示了类似的结果。在降低癌症患者中复发性VTE和DVT的风险，NOAC优于LMWH，且大出血不增加。
