Xin Zechang, Liu Fei, Du Yan, Mao Feiyu, Wang Xiaodong, Xu Peng, Li Zhennan, Qian Jianjun, Yao Jie
Dalian Medical University, Dalian, China.
Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Ann Palliat Med. 2020 Sep;9(5):2970-2981. doi: 10.21037/apm-20-47. Epub 2020 Aug 3.
Ambulatory cancer patients carry a high risk of venous thromboembolism (VTE). However, the optimal prophylaxis strategy remains controversial. This meta-analysis compared the effectiveness and safety of apixaban, rivaroxaban, low molecular weight heparin (LMWH), semuloparin, aspirin, and warfarin for the prevention of VTE in ambulatory cancer patients.
A systematic review and network meta-analysis was performed. PubMed, the Cochrane Central Register of Controlled Trails (CENTRAL) and EMBASE electronic databases were searched from inception to 26 April 2019. In the meta-analysis, 19 randomized controlled trials (RCTs) in ambulatory cancer patients administrated venous thromboprophylaxis agents were included. The primary outcome was the risk of VTE. Safety outcomes included the occurrence of major-bleeding. Two investigators identified the studies and performed data extraction. A network meta-analysis was performed and agents were ranked using cumulative ranking (SUCRA) probabilities.
We identified 19 studies, including 11,430 patients comparing 10 interventions. Compared to placebo controls, apixaban (5 mg) showed the highest efficacy for the prevention of VTE [odds ratio (OR) 0.36, 95% confidence interval (CI): 0.18-0.71, SUCRA=69.5] and was more effective than LMWH (OR 0.5, 0.39-0.63; SUCRA=52.1) or warfarin (OR 0.75, 95% CI: 0.35-1.59; SUCRA=25.6). Moreover, the safety of apixaban (5 mg) (OR 1.41, 95% CI: 0.33-5.93; SUCRA=58.5) was higher than LMWH (OR 1.96, 95% CI: 0.99-3.86; SUCRA=44.1) or warfarin (OR 3.06, 95% CI: 1.03-9.08; SUCRA=29.1). There were no significant differences between placebo and experimental groups in terms of patient deaths.
Anticoagulation therapies in ambulatory cancer patients can significantly reduce the risk of VTE. However, this protective effect was associated with a significantly increased risk of major bleeding. Apixaban at the appropriate dose can decrease the risk of VTE without increasing the bleeding risk. These findings require validation in larger study cohorts.
门诊癌症患者发生静脉血栓栓塞（VTE）的风险很高。然而，最佳预防策略仍存在争议。本荟萃分析比较了阿哌沙班、利伐沙班、低分子肝素（LMWH）、赛莫肝素、阿司匹林和华法林在预防门诊癌症患者VTE方面的有效性和安全性。
进行了一项系统评价和网状荟萃分析。检索了PubMed、Cochrane对照试验中央注册库（CENTRAL）和EMBASE电子数据库，检索时间从创建至2019年4月26日。在荟萃分析中，纳入了19项针对门诊癌症患者使用静脉血栓预防药物的随机对照试验（RCT）。主要结局是VTE风险。安全性结局包括大出血的发生情况。两名研究人员确定了这些研究并进行了数据提取。进行了网状荟萃分析，并使用累积排序（SUCRA）概率对药物进行了排名。
我们确定了19项研究，包括11430名患者，比较了10种干预措施。与安慰剂对照组相比，阿哌沙班（5 mg）在预防VTE方面显示出最高的疗效[比值比（OR）0.36，95%置信区间（CI）：0.18 - 0.71，SUCRA = 69.5]，并且比LMWH（OR 0.5，0.39 - 0.63；SUCRA = 52.1）或华法林（OR 0.75，95% CI：0.35 - 1.59；SUCRA = 25.6）更有效。此外，阿哌沙班（5 mg）的安全性（OR 1.41，95% CI：0.33 - 5.93；SUCRA = 58.5）高于LMWH（OR 1.96，95% CI：0.99 - 3.86；SUCRA = 44.1）或华法林（OR 3.06，95% CI：1.03 - 9.08；SUCRA = 29.1）。在患者死亡方面，安慰剂组和实验组之间没有显著差异。
门诊癌症患者的抗凝治疗可显著降低VTE风险。然而，这种保护作用与大出血风险的显著增加相关。适当剂量的阿哌沙班可降低VTE风险，而不增加出血风险。这些发现需要在更大的研究队列中进行验证。
