Bajpai Vijeta, Patel Tejas, Dwivedi Priyanka, Kabi Ankita, Mishra Amrita, Sharma Ravi Shankar, Gupta Astha, Gangwar Pradeepika, Agarwal Richa, Kishore Surekha
Department of Anaesthesiology, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, 273008, India.
Department of Pharmacology, All India Institute of Medical Sciences, Gorakhpur, Gorakhpur, Uttar Pradesh, 273008, India.
Cardiovasc Hematol Agents Med Chem. 2025;23(2):112-127. doi: 10.2174/0118715257331706240919172310.
venous thromboembolism (VTE) prophylaxis is crucial for reducing the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE). This network meta-analysis was carried out to determine the most effective intervention among selective Xa inhibitors and low molecular weight heparins (LMWHs) for perioperative surgical thromboprophylaxis in major abdominal, pelvic, lumbar spine, and lower limb surgeries.
A systematic literature search was conducted for randomized controlled trials (RCTs) comparing selective factor Xa inhibitors, LMWHs, and placebo as thromboprophylaxis agents in major abdominal, pelvic, lumbar spine, and lower limb surgeries. A Bayesian network metaanalysis was performed to compare all interventions for the risk of developing DVT, VTE, major VTE, total bleeding, and major bleeding. The surface under the cumulative ranking curves was used to rank all interventions.
Of 1788 retrieved references, 42 RCTs comparing 11 anticoagulants were included. As compared to enoxaparin, the risk of DVT was significantly reduced in patients treated with fondaparinux [RR: 0.53 (95% CrI: 0.31, 0.93)] and rivaroxaban [RR: 0.42 (95% CrI: 0.27, 0.64)]; VTE in patients treated with bemiparin [RR: 0.09 (95% CrI: 0, 0.7)], edoxaban [RR: 0.43 (95% CrI: 0.18, 0.96)], fondaparinux [RR: 0.55 (95% CrI: 0.34, 0.91)] and rivaroxaban [RR: 0.56 (95% CrI: 0.34, 0.85)]; major VTE in patients treated with rivaroxaban [RR: 0.26 (95% CrI: 0.11, 0.6)]. According to the surface under the cumulative ranking curves (SUCRA) value, fondaparinux and bemiparin increase the risk of serious bleeding more than other factor Xa inhibitors and LMWHs.
Rivaroxaban, fondaparinux, edoxaban, and bemiparin are superior perioperative thromboprophylaxis agents than enoxaparin in major surgeries. Fondaparinux and bemiparin have shown the highest risk of major bleeding compared to other factor Xa inhibitors and LMWHs.
静脉血栓栓塞症（VTE）预防对于降低深静脉血栓形成（DVT）和肺栓塞（PE）风险至关重要。本网络荟萃分析旨在确定在腹部、盆腔、腰椎和下肢大手术围手术期进行血栓预防时，选择性Xa抑制剂和低分子量肝素（LMWH）中最有效的干预措施。
对比较选择性Xa抑制剂、LMWH和安慰剂作为腹部、盆腔、腰椎和下肢大手术血栓预防药物的随机对照试验（RCT）进行系统文献检索。进行贝叶斯网络荟萃分析，以比较所有干预措施发生DVT、VTE、严重VTE、总出血和大出血的风险。使用累积排序曲线下面积对所有干预措施进行排名。
在检索到的1788篇参考文献中，纳入了42项比较11种抗凝剂的RCT。与依诺肝素相比，接受磺达肝癸钠治疗的患者发生DVT的风险显著降低[风险比（RR）：0.53（95%可信区间（CrI）：0.31，0.93）]，接受利伐沙班治疗的患者也是如此[RR：0.42（95%CrI：0.27，0.64）]；接受苄丙酮香豆素治疗的患者发生VTE的风险降低[RR：0.09（95%CrI：0，0.7）]，接受依度沙班治疗的患者也是如此[RR：0.43（95%CrI：0.18，0.96）]，接受磺达肝癸钠治疗的患者也是如此[RR：0.55（95%CrI：0.34，0.91）]，接受利伐沙班治疗的患者也是如此[RR：0.56（95%CrI：0.34，0.85）]；接受利伐沙班治疗的患者发生严重VTE的风险降低[RR：0.26（95%CrI：0.11，0.6）]。根据累积排序曲线下面积（SUCRA）值，与其他Xa因子抑制剂和LMWH相比，磺达肝癸钠和苄丙酮香豆素增加严重出血的风险更高。
在大手术中，利伐沙班、磺达肝癸钠、依度沙班和苄丙酮香豆素是比依诺肝素更优的围手术期血栓预防药物。与其他Xa因子抑制剂和LMWH相比，磺达肝癸钠和苄丙酮香豆素显示出大出血风险最高。
