对Cochrane抗凝综述的系统评价。
A systematic review of Cochrane anticoagulation reviews.
作者信息
Cundiff David Keith
机构信息
Los Angeles County Hospital and USC Medical Center, Long Beach, California, USA.
出版信息
Medscape J Med. 2009;11(1):5. Epub 2009 Jan 6.
CONTEXT
I coauthored a published review of anticoagulation for venous thromboembolism in the Cochrane Database of Systematic Reviews and published a review on the same topic in MedGenMed (now the Medscape Journal of Medicine). In contrast to the article in Medscape, the discussion and conclusions in the Cochrane review were altered appreciably during the review process. Consequently, I decided to critique all anticoagulation drug-related reviews and protocols in the Cochrane database with feedback letters concerning any issues of potential controversy.
EVIDENCE ACQUISITION
Using key words in the search engine of the Cochrane Reviews, I located reviews and protocols involving anticoagulant drugs. I critiqued each anticoagulation review and protocol and sent a total of 57 feedback letters to Cochrane concerning each publication to elicit a response/rebuttal from the authors.
EVIDENCE SYNTHESIS
Cochrane anticoagulation review editors acknowledged receipt of all letters. As of 12 months after receipt of my last letter, the Cochrane authors have replied to 13 of the 57 and agreed with many of my points. Two protocols were withdrawn after my feedback letters were acknowledged. The 58 Cochrane anticoagulation drug reviews, including mine, contained 9 categories of methodological errors (207 total instances) and 4 types of biases (18 total instances). This review of those Cochrane reviews suggests that the effectiveness of anticoagulants for 30 medical indications is questionable.
CONCLUSIONS
The efficacy of anticoagulants for treatment and prophylaxis for 30 current medical indications should be reconsidered by the scientific community and medical regulatory agencies. At least 50,000 people per year worldwide have fatal bleeding due to anticoagulant treatment or prophylaxis for these indications.
背景
我与人合作在《Cochrane系统评价数据库》上发表了一篇关于静脉血栓栓塞抗凝治疗的综述，并在《医学通用医学》（现《Medscape医学杂志》）上发表了关于同一主题的综述。与《Medscape》上的文章不同，Cochrane综述中的讨论和结论在评审过程中发生了明显变化。因此，我决定对Cochrane数据库中所有与抗凝药物相关的综述和方案进行批评，并就任何潜在争议问题发出反馈信。
证据获取
我在Cochrane系统评价的搜索引擎中使用关键词，找到了涉及抗凝药物的综述和方案。我对每一篇抗凝综述和方案进行了批评，并就每一篇发表的文章总共向Cochrane发送了57封反馈信，以促使作者作出回应/反驳。
证据综合
Cochrane抗凝综述编辑确认收到了所有信件。截至收到我最后一封信后的12个月，Cochrane的作者已回复了57封中的13封，并同意我的许多观点。在我的反馈信得到确认后，两项方案被撤回。包括我的在内的58篇Cochrane抗凝药物综述包含9类方法学错误（共207例）和4种偏倚（共18例）。对这些Cochrane综述的这项审查表明，抗凝剂对30种医学适应症的有效性值得怀疑。
结论
科学界和医学监管机构应重新考虑抗凝剂对目前30种医学适应症的治疗和预防效果。全球每年至少有5万人因这些适应症的抗凝治疗或预防而发生致命性出血。
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