Liu Yiwen, He Liyun, Han Shumeng, Ping Fan, Li Wei, Xu Lingling, Zhang Huabing, Li Yuxiu
Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences Beijing China.
J Am Heart Assoc. 2025 May 6;14(9):e039446. doi: 10.1161/JAHA.124.039446. Epub 2025 May 2.
Limited data exist on the association of glucagon-like peptide 1 receptor agonists (GLP-1RAs) with the risk of venous thromboembolism. This meta-analysis aimed to investigate the association between GLP-1RAs and the risk of venous thromboembolism including deep vein thrombosis (DVT) and pulmonary embolism.
A systematic search of PubMed, Web of Science, EMBASE, and Cochrane library was conducted from inception until July 3, 2024, to identify randomized controlled trials comparing GLP-1RAs with placebo or other anti-iabetic drugs, with reported data on DVT and pulmonary embolism. The primary outcome was venous thromboembolism, and secondary outcomes included DVT and pulmonary embolism. Pooled odds ratios (ORs) were calculated using fixed-effects models with Mantel-Haenszel method and treatment arm continuity correction for zero-event trials. A total of 39 randomized controlled trials involving 70 499 participants were included. A nonsignificant upward trend in the risk of venous thromboembolism was observed among participants using GLP-1RAs (OR, 1.19 [95% CI, 0.94-1.50]). GLP-1RAs were significantly associated with an increased risk of DVT (OR, 1.64 [95% CI, 1.14-2.36]); risk difference 25 (5-52) more events per 10 000 person-years). Subgroup analyses revealed that increased risk of DVT was particularly prominent in randomized controlled trials with treatment duration >1.5 years (OR, 2.32 [95% CI, 1.49-3.60]) and in cardiovascular outcome trials (OR, 2.18 [95% CI, 1.36-3.49]). No significant association was observed between GLP-1RAs and risk of pulmonary embolism.
GLP-1RAs might increase the risk of DVT, especially for long-term use of GLP-1RAs. Clinicians should be aware of this potential risk when prescribing GLP-1RAs.
关于胰高血糖素样肽1受体激动剂（GLP - 1RAs）与静脉血栓栓塞风险之间关联的数据有限。本荟萃分析旨在研究GLP - 1RAs与静脉血栓栓塞风险（包括深静脉血栓形成（DVT）和肺栓塞）之间的关联。
从数据库建立至2024年7月3日，对PubMed、科学网、EMBASE和Cochrane图书馆进行系统检索，以识别比较GLP - 1RAs与安慰剂或其他抗糖尿病药物，并报告了DVT和肺栓塞数据的随机对照试验。主要结局为静脉血栓栓塞，次要结局包括DVT和肺栓塞。使用固定效应模型和Mantel - Haenszel方法计算合并比值比（OR），并对零事件试验进行治疗组连续性校正。共纳入39项涉及70499名参与者的随机对照试验。使用GLP - 1RAs的参与者中观察到静脉血栓栓塞风险有不显著的上升趋势（OR，1.19 [95% CI，0.94 - 1.50]）。GLP - 1RAs与DVT风险增加显著相关（OR，1.64 [95% CI，1.14 - 2.36]）；风险差异为每10000人年多25（5 - 52）例事件。亚组分析显示，在治疗持续时间>1.5年的随机对照试验（OR，2.32 [95% CI，1.49 - 3.60]）和心血管结局试验（OR，2.18 [95% CI，1.36 - 3.49]）中，DVT风险增加尤为突出。未观察到GLP - 1RAs与肺栓塞风险之间存在显著关联。
GLP - 1RAs可能会增加DVT风险，尤其是长期使用GLP - 1RAs时。临床医生在开具GLP - 1RAs处方时应意识到这种潜在风险。
