Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China.
Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China; West China Brain Research Centre, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China.
Eur J Intern Med. 2023 Jul;113:22-30. doi: 10.1016/j.ejim.2023.03.032. Epub 2023 Apr 5.
There are knowledge gaps regarding the comparative efficacy and safety of various venous thromboprophylaxis regimens with extended timing in patients hospitalized for acute medical illnesses. This study aims to investigate the optimal regimen for the prevention of venous thromboembolism in these patients.
We conducted a Bayesian network meta-analysis of randomized controlled trials (RCTs) comparing different venous thromboprophylaxis regimens for acutely ill medical patients. Outcomes included venous thromboembolism, major bleeding, and all-cause mortality. Risk ratios (RR) and associated 95% credible interval (CrI) were estimated. In addition, we assessed the most effective interventions in a subgroup of patients with stroke.
We identified five RCTs involving 40,124 patients. Extended thromboprophylaxis with direct oral anticoagulant (DOAC) (RR 0.78, 95% CrI 0.68 to 0.89) and low molecular weight heparin (LMWH) (RR 0.62, 95% CrI 0.45 to 0.84) were superior to standard therapy in the prevention of venous thromboembolism. However, both of them (DOAC: RR 1.99, 95% CrI 1.38 to 2.92; LMWH: RR 2.56, 95% CrI 1.26 to 5.68) lead to a significant increase in major bleeding). Moreover, both LMWH (RR 0.76, 95% CrI 0.57 to 1.00) and DOAC (RR 0.86, 95% CrI 0.76 to 0.98) with extended thromboprophylaxis showed favorable net clinical benefit compared to standard therapy.
Extended thromboprophylaxis, especially with LMWH, showed better efficacy in venous thromboembolism reduction with increased risk of major bleeding. The beneficial effect of LMWH with extended timing has also been shown in stroke patients. Overall, extended thromboprophylaxis is associated with a positive net clinical benefit.
在急性内科疾病住院患者中，具有延长时间的各种静脉血栓预防方案的比较疗效和安全性方面存在知识空白。本研究旨在探讨预防这些患者静脉血栓栓塞症的最佳方案。
我们对比较急性内科疾病住院患者不同静脉血栓预防方案的随机对照试验（RCT）进行了贝叶斯网络荟萃分析。结局包括静脉血栓栓塞症、大出血和全因死亡率。风险比（RR）和相关 95%可信区间（CrI）进行了估计。此外，我们还在亚组患者中评估了最有效的干预措施。
我们确定了五项涉及 40124 名患者的 RCT。与标准治疗相比，延长时间的直接口服抗凝剂（DOAC）（RR0.78，95%CrI0.68 至 0.89）和低分子肝素（LMWH）（RR0.62，95%CrI0.45 至 0.84）在预防静脉血栓栓塞症方面更有效。然而，两者（DOAC：RR1.99，95%CrI1.38 至 2.92；LMWH：RR2.56，95%CrI1.26 至 5.68）均显著增加大出血风险。此外，与标准治疗相比，LMWH（RR0.76，95%CrI0.57 至 1.00）和 DOAC（RR0.86，95%CrI0.76 至 0.98）的延长时间的血栓预防均显示出有利的净临床获益。
延长时间的血栓预防，尤其是 LMWH，在降低静脉血栓栓塞症风险的同时，增加了大出血的风险。LMWH 延长时间的有益效果在中风患者中也得到了证实。总体而言，延长时间的血栓预防与积极的净临床获益相关。
