Vedovati Maria Cristina, Germini Federico, Agnelli Giancarlo, Becattini Cecilia
Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Perugia, Italy.
Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Perugia, Italy.
Chest. 2015 Feb;147(2):475-483. doi: 10.1378/chest.14-0402.
Direct oral anticoagulants (DOAs) have been shown to be as effective and at least as safe as conventional anticoagulation for the prevention of recurrences in patients with VTE. Whether this is the case in patients with cancer-associated VTE remains undefined.
We performed a meta-analysis of randomized controlled trials with the aim of assessing the efficacy and safety of DOAs in patients with VTE and cancer. MEDLINE, EMBASE, and CENTRAL were searched up to December 2013 with no language restriction. The primary outcome of the analysis was recurrent VTE. Data on major bleeding (MB) and clinically relevant nonmajor bleeding were analyzed. Data were pooled and compared by ORs and 95% CIs.
Overall, 10 studies comparing DOAs with conventional anticoagulation for treatment of VTE including patients with cancer were included in the review. Six studies were included in the meta-analysis (two with dabigatran, two with rivaroxaban, one with edoxaban, and one with apixaban), accounting for a total of 1,132 patients. VTE recurred in 23 of 595 (3.9%) and in 32 of 537 (6.0%) patients with cancer treated with DOAs and conventional treatment, respectively (OR, 0.63; 95% CI, 0.37-1.10; I2, 0%). MB occurred in 3.2% and 4.2% of patients receiving DOAs and conventional treatment, respectively (OR, 0.77; 95% CI, 0.41-1.44; I2, 0%).
DOAs seem to be as effective and safe as conventional treatment for the prevention of VTE in patients with cancer. Further clinical trials in patients with cancer-associated VTE should be performed to confirm these results.
直接口服抗凝剂（DOA）已被证明在预防静脉血栓栓塞（VTE）患者复发方面与传统抗凝治疗同样有效且至少同样安全。在癌症相关VTE患者中是否如此仍不明确。
我们进行了一项随机对照试验的荟萃分析，旨在评估DOA在VTE和癌症患者中的疗效和安全性。检索了截至2013年12月的MEDLINE、EMBASE和CENTRAL，无语言限制。分析的主要结局是复发性VTE。分析了大出血（MB）和临床相关非大出血的数据。数据通过比值比（OR）和95%置信区间（CI）进行汇总和比较。
总体而言，本综述纳入了10项比较DOA与传统抗凝治疗VTE（包括癌症患者）的研究。荟萃分析纳入了6项研究（两项使用达比加群，两项使用利伐沙班，一项使用依度沙班，一项使用阿哌沙班），共1132例患者。接受DOA和传统治疗的癌症患者中，分别有595例中的23例（3.9%）和537例中的32例（6.0%）发生VTE复发（OR，0.63；95%CI，0.37 - 1.10；I²，0%）。接受DOA和传统治疗的患者中，分别有3.2%和4.2%发生MB（OR，0.77；95%CI，0.41 - 1.44；I²，0%）。
DOA在预防癌症患者VTE方面似乎与传统治疗同样有效且安全。应进行更多关于癌症相关VTE患者的临床试验以证实这些结果。
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