Department of Cardiology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.
Department of Cardiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China.
Clin Appl Thromb Hemost. 2024 Jan-Dec;30:10760296241257931. doi: 10.1177/10760296241257931.
Direct oral anticoagulants (DOACs) are becoming increasingly popular clinically, but their safety and effectiveness profile in patients with chronic thromboembolic pulmonary hypertension (CTEPH) is not well-established. Literature from the PubMed and EMBASE databases was systematically screened up to February 2024 to identify relevant studies on the use of DOACs in CTEPH patients. The bias risk of RCTs was assessed using the Cochrane Risk of Bias Tool 2.0. The quality of observational prospective cohorts was assessed using the Newcastle-Ottawa Scale tool. Data pooled from different studies were analyzed. Results from 4 studies were gathered, including 2 randomized controlled trials and 2 prospective cohorts, with a total of 2038 patients, of which 751 were on DOACs and 1287 were on vitamin K antagonists (VKAs). Similar rates of all-cause mortality (3.33% vs 3.33%, RD = -0.01%, 95% CI [-0.02%, 0.00%], = .17), VTE recurrence (1.46% vs 2.12%, RD = -0.00%, 95% CI [-0.01%, 0.01%], = .92) were observed. DOACs were associated with a nonsignificant reduction in bleeding events including major bleeding (2.22% vs 3.71%, RD = -0.01%, 95% CI [-0.04%, 0.01%], = .30), any bleeding (5.33% vs 9.94%, RD = -0.03%, 95% CI [-0.07%, 0.01%], = .10), and minor bleeding (4.17% vs 13.3%, RD = -0.06%, 95% CI [-0.23%, 0.10%], = .45). Data pooled from existing perspective trials suggests the use of DOACs in CTEPH patients as an effective and safe alternative to VKAs.
直接口服抗凝剂（DOACs）在临床上越来越受欢迎，但它们在慢性血栓栓塞性肺动脉高压（CTEPH）患者中的安全性和有效性尚未得到充分证实。从 PubMed 和 EMBASE 数据库系统筛选了截至 2024 年 2 月的相关研究，以确定 DOACs 在 CTEPH 患者中的应用。使用 Cochrane 偏倚风险工具 2.0 评估 RCT 的偏倚风险。使用纽卡斯尔-渥太华量表工具评估前瞻性队列观察研究的质量。对不同研究的数据进行了汇总分析。共收集了 4 项研究的结果，包括 2 项随机对照试验和 2 项前瞻性队列研究，共纳入 2038 例患者，其中 751 例接受 DOACs 治疗，1287 例接受维生素 K 拮抗剂（VKAs）治疗。全因死亡率（3.33%比 3.33%，RD=-0.01%，95%CI[-0.02%，0.00%]， = .17）和 VTE 复发率（1.46%比 2.12%，RD=-0.00%，95%CI[-0.01%，0.01%]， = .92）相似。DOACs 与出血事件（包括大出血：2.22%比 3.71%，RD=-0.01%，95%CI[-0.04%，0.01%]， = .30；任何出血：5.33%比 9.94%，RD=-0.03%，95%CI[-0.07%，0.01%]， = .10；轻微出血：4.17%比 13.3%，RD=-0.06%，95%CI[-0.23%，0.01%]， = .45）的减少相关，但无统计学意义。现有前瞻性试验的数据汇总表明，DOACs 作为 VKAs 的有效且安全的替代药物，可用于 CTEPH 患者。
