Al Lami Bareq S, Aziz Shad B, Al-Tawil Yousif N, Aras Rawen, Dlshad Blnd D, Wilya Rose, Slevanay Hanan, Sarkawt Zahraa, Fadhel Taha, Salahaddin Avin, Abdulla Lazha, Hussein Gunai, Abdulwahhab Vena, Albarznji Hivi
General Medicine, Hawler Medical University, Erbil, IRQ.
College of Medicine, Hawler Medical University, Erbil, IRQ.
Cureus. 2024 Sep 24;16(9):e70078. doi: 10.7759/cureus.70078. eCollection 2024 Sep.
Acute lymphoblastic leukemia (ALL) is a common malignancy in children, often treated with intensive chemotherapy regimens. Venous thromboembolism (VTE) poses a significant risk during ALL treatment, leading to suboptimal outcomes. Thromboprophylaxis is crucial in mitigating this risk, but its efficacy and safety remain uncertain. This systematic review and meta-analysis aimed to evaluate the effectiveness of thromboprophylaxis in reducing VTE incidence during ALL treatment, focusing on antithrombin, apixaban, and enoxaparin. A systematic literature search adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Randomized controlled trials (RCTs) investigating thromboprophylaxis in ALL were included. Data extraction and quality appraisal were performed independently by three authors. Meta-analysis was conducted using Review Manager software. Three RCTs met the inclusion criteria. Apixaban, enoxaparin, and antithrombin were assessed in these trials. Meta-analysis revealed significantly reduced odds of VTE with thromboprophylaxis compared to standard care (odds ratio (OR): 0.47, 95% confidence interval (CI) 0.29-0.75; relative risk (RR): 0.52, 95% CI 0.33-0.83). However, no significant difference in bleeding risk was observed (OR: 1.33, 95% CI 0.42-4.21; RR: 1.32, 95% CI 0.43-4.07). Heterogeneity among studies was moderate. This study showed that thromboprophylaxis with apixaban, enoxaparin, or antithrombin significantly reduces VTE incidence during ALL treatment. Despite some limitations, including heterogeneity and potential biases, these findings support the adoption of tailored thromboprophylaxis strategies to improve outcomes in ALL patients. Further research is warranted to optimize these approaches and address remaining uncertainties.
急性淋巴细胞白血病（ALL）是儿童常见的恶性肿瘤，通常采用强化化疗方案进行治疗。静脉血栓栓塞（VTE）在ALL治疗期间构成重大风险，导致治疗效果欠佳。血栓预防对于降低这一风险至关重要，但其疗效和安全性仍不确定。本系统评价和荟萃分析旨在评估血栓预防在降低ALL治疗期间VTE发生率方面的有效性，重点关注抗凝血酶、阿哌沙班和依诺肝素。按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行了系统的文献检索。纳入了调查ALL血栓预防的随机对照试验（RCT）。由三位作者独立进行数据提取和质量评估。使用Review Manager软件进行荟萃分析。三项RCT符合纳入标准。这些试验评估了阿哌沙班、依诺肝素和抗凝血酶。荟萃分析显示，与标准治疗相比，血栓预防显著降低了VTE的发生几率（优势比（OR）：0.47，95%置信区间（CI）0.29 - 0.75；相对风险（RR）：0.52，95%CI 0.33 - 0.83）。然而，未观察到出血风险有显著差异（OR：1.33，95%CI 0.42 - 4.21；RR：1.32，95%CI 0.43 - 4.07）。研究之间的异质性为中等。本研究表明，使用阿哌沙班、依诺肝素或抗凝血酶进行血栓预防可显著降低ALL治疗期间的VTE发生率。尽管存在一些局限性，包括异质性和潜在偏倚，但这些发现支持采用针对性的血栓预防策略以改善ALL患者的治疗效果。有必要进一步开展研究以优化这些方法并解决尚存的不确定性。
