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支架置入或血管成形术治疗深静脉血栓形成:随机对照试验的系统评价和荟萃分析。

Stenting or angioplasty for the treatment of deep vein thrombosis: Systematic review and meta-analysis of randomized controlled trials.

机构信息

Division of Vascular and Endovascular Surgery, Department of Surgery, Universidade Federal de São Paulo, São Paulo, Brazil.

Cochrane Brazil, Universidade Federal de São Paulo, São Paulo, Brazil.

出版信息

Medicine (Baltimore). 2023 Jun 2;102(22):e33924. doi: 10.1097/MD.0000000000033924.


DOI:10.1097/MD.0000000000033924
PMID:37266612
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10237682/
Abstract

BACKGROUND: Although the cornerstone treatment for deep vein thrombosis (DVT) remains anticoagulation, clinicians perform stenting or angioplasty (SA) in particular patients. To assess the effects of SA in this setting, we performed a systematic review of randomized controlled trials. METHODS: Based on the Cochrane standards, we searched the Cochrane CENTRAL, MEDLINE, Embase, CINAHL, LILACS and IBECS databases, and trial registries. Our primary outcomes were post-thrombotic syndrome (PTS), venous thromboembolism (VTE) and all-cause mortality. RESULTS: We included 7 randomized controlled trial (1485 participants). There was no clinically significant difference between SA and best medical practice (BMP) for the additional treatment of acute DVT regarding PTS (standardized mean difference -7.87, 95% confidence interval [CI] -12.13 to -3.61; very low-certainty) and VTE (risk ratio [RR] 1.19, 95% CI 0.28-5.07, very low-certainty), and no deaths. Compared to BMP, the SA plus BMP and thrombolysis results in little to no difference in PTS (mean difference [MD] -1.07, 95% CI -1.12 to -1.02, moderate-certainty), VTE (RR 1.48, 95% CI 0.95-2.31, low-certainty), and mortality (RR 0.92, 95% CI 0.34-2.52, low-certainty). There was no clinical difference between stenting and BMP for chronic DVT regarding PTS (MD 2.73, 95% CI -2.10 to 7.56, very low certainty) and no VTE and death events. CONCLUSIONS: SA results in little to no difference in PTS, VTE and mortality in acute DVT compared to BMP. The evidence regarding SA in chronic DVT and whether SA, compared to BMP and thrombolysis, decreases PTS and VTE in acute DVT is uncertain. Open Science Framework (osf.io/f2dm6).

摘要

背景:尽管抗凝治疗仍然是深静脉血栓形成(DVT)的基石治疗方法,但临床医生会在特定患者中进行支架置入或血管成形术(SA)。为了评估这种情况下 SA 的效果,我们对随机对照试验进行了系统评价。

方法:根据 Cochrane 标准,我们检索了 Cochrane 中心、MEDLINE、Embase、CINAHL、LILACS 和 IBECS 数据库以及试验注册处。我们的主要结局是血栓后综合征(PTS)、静脉血栓栓塞(VTE)和全因死亡率。

结果:我们纳入了 7 项随机对照试验(1485 名参与者)。在急性 DVT 的额外治疗中,SA 与最佳药物治疗(BMP)相比,在 PTS(标准化均数差-7.87,95%置信区间[CI] -12.13 至-3.61;极低确定性)和 VTE(风险比[RR] 1.19,95%CI 0.28-5.07,极低确定性)方面没有临床意义上的差异,也没有死亡。与 BMP 相比,SA 加 BMP 和溶栓治疗在 PTS(平均差-1.07,95%CI -1.12 至-1.02,中等确定性)、VTE(RR 1.48,95%CI 0.95-2.31,低确定性)和死亡率(RR 0.92,95%CI 0.34-2.52,低确定性)方面几乎没有差异。在慢性 DVT 中,支架置入与 BMP 相比,在 PTS(MD 2.73,95%CI -2.10 至 7.56,极低确定性)和无 VTE 和死亡事件方面没有临床差异。

结论:与 BMP 相比,SA 在急性 DVT 中对 PTS、VTE 和死亡率几乎没有影响。关于慢性 DVT 中 SA 的证据,以及与 BMP 和溶栓治疗相比,SA 是否能降低急性 DVT 中的 PTS 和 VTE,证据尚不确定。开放科学框架(osf.io/f2dm6)。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2403/10237682/c11adf20c0a6/medi-102-e33924-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2403/10237682/73eca684236f/medi-102-e33924-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2403/10237682/c11adf20c0a6/medi-102-e33924-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2403/10237682/73eca684236f/medi-102-e33924-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2403/10237682/c11adf20c0a6/medi-102-e33924-g002.jpg

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引用本文的文献

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[2]
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本文引用的文献

[1]
Pharmacological interventions for preventing venous thromboembolism in people undergoing bariatric surgery.

Cochrane Database Syst Rev. 2022-11-22

[2]
Antiplatelet agents for the treatment of deep venous thrombosis.

Cochrane Database Syst Rev. 2022-7-25

[3]
External validation of Villalta score in high-middle income country patients with deep vein thrombosis.

Medicine (Baltimore). 2022-6-17

[4]
Anticoagulants for people hospitalised with COVID-19.

Cochrane Database Syst Rev. 2022-3-4

[5]
Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report.

Chest. 2021-12

[6]
The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.

BMJ. 2021-3-29

[7]
Thrombolytic strategies versus standard anticoagulation for acute deep vein thrombosis of the lower limb.

Cochrane Database Syst Rev. 2021-1-19

[8]
Editor's Choice - European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis.

Eur J Vasc Endovasc Surg. 2021-1

[9]
Association of Successful Ultrasound-Accelerated Catheter-Directed Thrombolysis with Postthrombotic Syndrome: A Post Hoc Analysis of the CAVA Trial.

Thromb Haemost. 2020-8

[10]
ACR Appropriateness Criteria® Radiologic Management of Iliofemoral Venous Thrombosis.

J Am Coll Radiol. 2020-5

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