癌症相关静脉血栓栓塞症(CA-VTE)患者的最佳治疗方案尚不清楚。因此,作者试图比较CA-VTE患者(VKAs)与直接阿哌沙班和低分子量肝素(LMWH)的结局.
■MEDLINE,Embase,在CochraneCentral数据库中搜索了比较阿哌沙班和LMWH在CA-VTE患者中的疗效和安全性的随机对照试验(RCT)和观察性研究.大出血,临床相关非大出血(CRNMB),肺栓塞(PE)复发,深静脉血栓形成(DVT)和出血相关死亡率是关注的结局.使用Mantel-Haenszel加权随机效应模型计算95%CI的相对风险(RR)。
■分析包括来自3项随机对照试验和2项观察性研究的12.011例患者。与LMWH相比,阿哌沙班可显著降低大出血风险[RR0.67(95%CI0.54,0.83);P=0.0003,I2=0%],但未显著改变临床相关非大出血风险[RR0.96(95%CI0.64,0.1.45);P=0.85,I2=57%].与服用LMWH的患者相比,服用阿哌沙班的患者PE复发的风险明显降低,根据荟萃分析[RR0.56(95%CI0.32,0.99);P=0.05,I2=0%]。阿哌沙班和LMWH在出血相关死亡事件中没有明显差异[RR0.20(95%CI0.01,4.18);P=0.30,I2=NA%],和DVT复发[RR0.60(95%CI0.22,1.59);P=0.23,I2=32%]。
■由于其严重出血的风险较低,PE复发减少,阿哌沙班可能是CA-VTE的优选治疗选择,但需要更多的研究来验证这些结论并评估其长期疗效和安全性.
UNASSIGNED: The optimal treatment regimen for patients with cancer-associated venous thromboembolism (CA-VTE) remains unclear. Therefore, the authors sought to compare the outcomes of (VKAs) versus direct apixaban and low molecular weight heparin (LMWH) in patients with CA-VTE.
UNASSIGNED: MEDLINE, Embase, and Cochrane Central databases were searched for randomized controlled trials (RCTs) and observational studies comparing the efficacy and safety of apixaban and LMWH in patients with CA-VTE. Major bleeding, clinically relevant non-major bleeding (CRNMB), recurrence of pulmonary embolism (PE), deep venous thrombosis (DVT) and bleeding-related mortality were among outcomes of interest. Mantel-Haenszel weighted random-effects model was used to calculate relative risks (RRs) with 95% CIs.
UNASSIGNED: The analysis included 12 011 patients from 3 RCTs and 2 observational studies. Compared to LMWH, apixaban significantly decreased the risk of major bleeding [RR 0.67 (95% CI 0.54, 0.83); P=0.0003, I2=0%] without significantly changing the risk of clinically relevant non-major bleeding [RR 0.96 (95% CI 0.64, 0.1.45); P=0.85, I2=57%]. Patients on apixaban had a noticeably reduced the risk of recurrence of PE than those taking LMWH, according to a meta-analysis [RR 0.56 (95% CI 0.32, 0.99); P=0.05, I2=0%]. There was no discernible difference between apixaban and LMWH in bleeding-related mortality events [RR 0.20 (95% CI 0.01, 4.18); P=0.30, I2=NA%], and recurrence of DVT [RR 0.60 (95% CI 0.22, 1.59); P=0.23, I2=32%].
UNASSIGNED: Due to its lower risk of severe bleeding and reduced PE recurrence, apixaban may be a preferable treatment option for CA-VTE, but additional research is required to validate these conclusions and evaluate its long-term efficacy and safety.