Huang Zhencheng, Chen Meiyi, Sun Hao, Li Deng, Cai Zhiqing, Lin Zhencan, Liu Fangzhou, Ma Shuqiang, Xu Jie, Ma Ruofan
Department of Orthopedic, the Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China; Department of Orthopedic, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.
Department of Orthopedic, the Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China.
Ann Vasc Surg. 2024 Jan;98:282-292. doi: 10.1016/j.avsg.2023.08.015. Epub 2023 Oct 5.
Isolated calf muscular vein thrombosis (ICMVT) can result in pulmonary embolism, but the treatment of ICMVT remains controversial. Therefore, the purpose of the present study was to investigate the optimal treatment for the ICMVT by comparing the efficacy and safety of different treatments.
A network meta-analysis was conducted to search for studies published from database inception to April 30, 2022, that compared the outcomes of 2 or more treatments for ICMVT. The primary outcomes were efficacy (resolution rate) and safety (adverse reactions). Data were extracted following predefined hierarchy and the Cochrane Collaboration risk of bias tool was used to evaluate the methodological quality of the included studies. We estimated summary odds ratios with 95% credibility intervals using Bayesian network meta-analysis with random effects.
A total of 16 studies were enrolled in the study. In terms of efficacy and safety, urokinase thrombolysis combined with low-molecular-weight heparin (LMWH) was most effective but had the lowest safety, while physical therapy was safest but had the lowest efficacy. More important, direct oral factor Xa inhibitors were most likely to be second most effective and safe compared with other treatments. For the duration of treatment, anticoagulant therapy for at least 3 months could effectively increase the resolution rate of ICMVT.
Considering both efficacy and safety, taking direct oral factor Xa inhibitors for at least 3 months was the optimal treatment compared to LMWH, urokinase thrombolysis combined LMWH, physical therapy and warfarin for patients with ICMVT.
孤立性小腿肌静脉血栓形成（ICMVT）可导致肺栓塞，但ICMVT的治疗仍存在争议。因此，本研究的目的是通过比较不同治疗方法的疗效和安全性，探讨ICMVT的最佳治疗方法。
进行网络荟萃分析，以检索从数据库建立到2022年4月30日发表的比较ICMVT两种或更多种治疗方法结果的研究。主要结局为疗效（溶解率）和安全性（不良反应）。按照预定义的层次结构提取数据，并使用Cochrane协作网偏倚风险工具评估纳入研究的方法学质量。我们采用随机效应的贝叶斯网络荟萃分析估计95%可信区间的汇总比值比。
本研究共纳入16项研究。在疗效和安全性方面，尿激酶溶栓联合低分子肝素（LMWH）最有效，但安全性最低，而物理治疗最安全，但疗效最低。更重要的是，与其他治疗方法相比，直接口服Xa因子抑制剂最有可能是第二有效的且安全的。在治疗持续时间方面，抗凝治疗至少3个月可有效提高ICMVT的溶解率。
综合考虑疗效和安全性，对于ICMVT患者，与LMWH、尿激酶溶栓联合LMWH、物理治疗和华法林相比，服用直接口服Xa因子抑制剂至少3个月是最佳治疗方法。
