利伐沙班、达比加群与肝素在全髋或全膝置换后的抗凝治疗

背景:目前临床上主要使用依诺肝素预防全髋或全膝置换后静脉血栓形成,但其并非百分之百的有效与安全. 目的:系统评价新型口服抗凝药利伐沙班和达比加群与依诺肝素在临床随机对照试验中预防全髋或全膝置换后静脉血栓形成的有效性和安全性. 方法:计算机检索 Pubed、ScienceDirect、Cochrane Library、CBM、CNKI,收集有关利伐沙班、达比加群与依诺肝素在全髋或全膝置换后抗凝治疗有效性和安全性的临床随机对照试验,并评价纳入研究的方法学质量,统计软件用 RevMan5.1.0. 结果与结论:共纳入14个临床随机对照试验,共17212例患者.Meta 分析显示,利伐沙班组总静脉血栓发生率、大静脉血栓及有症状静脉血栓发生率均低于依诺肝素组;利伐沙班和达比加群组深静脉血栓发生率低于依诺肝素组;利伐沙班和达比加群与依诺肝素在出血率方面差异无显著性意义.提示新型口服抗凝药对全髋或全膝置换后深静脉血栓的预防效果优于依诺肝素,且利伐沙班优于达比加群.     

髋关节置换术后深静脉血栓的危险因素：系统回顾和荟萃分析

目的 探讨髋关节置换术后发生下肢深静脉血栓(DVT)形成的危险因素。方法 检索PubMed、Embase、Cochrane Library、中国知网(CNKI)、万方、维普和中国生物医学文献数据库(CBM),收集数据库建立至2022年8月期间髋关节置换术患者DVT危险因素的病例对照研究、队列研究和横断面研究。由两位作者独立筛选文献、提取数据并评估纳入文献的偏倚风险后，采用Stata 16.0软件进行荟萃分析。结果 纳入27项研究，共82872名患者，存在16个危险因素。荟萃分析结果显示：女性[OR=3.06,95%CI(1.36,6.88),P=0.0001]、年龄[OR=2.04,95%CI(1.73,2.42),P<0.0001]、BMI[OR=0.73,95%CI(0.45,1.19),P=0.21]、高血压[OR=2.52,95%CI(1.42,4.46),P<0.0001]、高脂血症[OR=2.47,95%CI(1.44,4.24),P<0.0001]、合并心血管基础疾病[OR=2.53,95%CI(1.47,4.37),P<0.0001]、既往静脉曲...     

全髋、膝关节置换术病人术后恶心呕吐危险因素的Meta分析

目的:系统评价全髋关节置换术(THA)和全膝关节置换术(TKA)病人术后恶心呕吐(PONV)的危险因素。方法:系统检索the Cochrane Library、EMbase、PubMed、Web of Knowledge、中国知网、万方数据库、维普数据库中公开发表的关于THA/TKA病人发生PONV危险因素的研究,检索时限为数据库建库至2021年10月22日。由2名研究员根据纳入和排除标准独立进行文献筛选、数据提取,进行质量评价后使用Review Manager 5.3软件进行Meta分析。结果:最终纳入8篇文献。Meta分析结果显示,女性[OR=2.43,95%CI(1.78,3.31),P<0.000 01]、有PONV史[OR=5.18,95%CI(2.86,9.37),P<0.000 01]、有晕动症史[OR=4.75,95%CI(2.72,8.29),P<0.000 01]、术中使用阿片类药物[OR=1.82,95%CI(1.34,2.47),P=0.000 1]、体质指数(BMI)较低[OR=0.70,95%CI(0.60,0.83),P<0.01]...     

心房颤动患者华法林抗凝治疗效果和安全性的Meta分析

目的评价华法林抗凝治疗心房颤动患者疗效和安全性。方法计算机检索Cochranelibrary,Pubmed,EMBASE,万方数据库,中国学术期刊全文数据库(CNKI),中国生物医学文献数据库(CBM),维普数据库(VIP)至2017年4月,收集有关华法林抗凝治疗心房颤动患者的疗效和安全性随机对照试验(RCT),按纳入标准及排除标准选择文献,提取资料,并进行方法学质量评估,使用Stata 12.0软件进行Meta分析。结果最终纳入20项研究,研究对象2194例。Meta分析结果:华法林组的抗凝效果优于阿司匹林:脑梗死发生率低于阿司匹林组(OR=0.15,95%CI:0.08~0.29,P0.05);脑卒中发生率低于阿司匹林组(OR=0.35,95%CI:0.22~0.57,P0.05);外周动脉栓塞发生率低于阿司匹林组(OR=0.42,95%CI:0.25~0.71,P=0.001);死亡发生率低于阿司匹林组(OR=0.28,95%CI:0.14~0.59,P=0.001);华法林组与阿司匹林组出血事件发生率差异无统计学意义(OR=0.90,95%CI:0.66~1.22,P=0.488)。结论华法林的安全性与阿司匹林相似,但华法林对于心房颤动患者的疗效优于阿司匹林。     

全髋关节置换术患者恐动症现状及其影响因素分析

目的 调查全髋关节置换术患者术后恐动症现状及其影响因素。方法 采用便利抽样法,选取2021年6月至2022年2月首次行全髋关节置换术的175例患者为研究对象,使用一般资料调查表、恐动症评分表、社会支持评定量表、康复锻炼自我效能量表、疼痛数字评分表进行调查。采用单因素分析及多因素logistic回归分析全髋关节置换术患者恐动症的影响因素。结果 175例全髋关节置换术患者恐动症发生率42.3%,logistic回归分析显示女性(OR=0.272,95%CI=0.100～0.741)、文化程度(OR=0.168,95%CI=0.055～0.514)、疼痛(OR=2.376,95%CI=1.496～3.774)、客观支持(OR=0.220,95%CI=0.094～0.510)、应对自我效能(OR=0.814,95%CI=0.698～0.950)是恐动症发生的独立预测因素。结论 全髋关节置换术患者恐动症发生率处于较高水平,女性、文化程度低、疼痛、客观支持及应对自我效能低更易发生恐动症,医护人员可根据影响因素制定干预方案,以改善患者康复结局。     

全髋关节置换后应用利伐沙班安全性的Meta分析

背景：利伐沙班预防全髋关节置换后静脉血栓的疗效已经得到诸多实验的证明,但有关其安全性实验结果并不一致。目的：系统评价利用伐沙班和依诺肝素预防全髋关节置换后静脉血栓的安全性。方法：全面检索国内外关于利伐沙班和依诺肝素预防全髋关节置换术后静脉血栓的随机对照研究文献,筛选出符合评价标准的文献,采用RevMan5.1软件进行Meta分析。结果与结论：纳入随机对照研究文献6篇,其中5篇英文和1篇中文,全部样本量合计9611例。荟萃分析结果显示：全髋关节置换后应用利伐沙班的大出血事件发生率高于依诺肝素,RR为1.75（95%CI,0.76-4.04）,Z=1.31（P=0.19）;临床非大出血事件发生率高于依诺肝素,RR为1.29（95%CI,0.99-1.68）,Z=1.85（P=0.06）;小出血事件发生率稍低于依诺肝素,RR为0.98（95%CI,0.76-1.25）,Z=0.20（P=0.84）;总出血事件发生率稍高于依诺肝素,RR为1.13（95%CI,0.95-1.35）,Z=1.38（P=0.17）。提示全髋关节置换后使用利伐沙班预防静脉血栓栓塞的安全性与依诺肝素相当,差异无显著性意义。     

间歇充气加压预防骨科住院病人静脉血栓的Meta分析

[目的]系统评价下肢间歇充气加压(IPC)对骨科住院病人静脉血栓的预防效果。[方法]计算机检索Cochrane图书馆、JBI循证护理中心图书馆、MEDLINE、Embase、PubMed、中国知网数据库(CNKI)、维普数据库(VIP)、万方数据库,收集所有关于下肢IPC对预防住院病人静脉血栓的随机对照试验和临床对照研究;按照纳入和排除标准独立检索文献、筛选文献、评价纳入文献的质量,并提取资料,使用Revman5.3软件进行Meta分析。[结果]共纳入44篇文献,均为随机对照试验。Meta分析结果显示:IPC与空白组比较[随机效应模型OR=0.37,95%CI(0.25,0.56),P0.000 01],与弹力袜比较[固定效应模型OR=0.39,95%CI(0.22,0.69),P=0.001],低分子肝素+IPC与仅低分子肝素比较[固定效应模型OR=0.21,95%CI(0.12,0.36),P0.000 01],住院病人静脉血栓发生率降低。[结论]IPC能降低住院病人静脉血栓发生率,结合抗凝药物使用效果更佳。     

经外周静脉穿刺中心静脉置管与其他中心静脉置管相关性静脉血栓的meta分析

目的通过系统分析比较经外周静脉穿刺中心静脉置管(peripherally inserted central catheters,PICCs)和其他中心静脉置管(centralvenous catheters,CVCs)相关性静脉血栓发生风险。方法检索PubMed数据库、Cochrane临床试验数据库、中国知网(CNKI)、中国生物医学文献数据库(CBM)和万方数据库,查找PICCs和CVCs相关静脉血栓发生风险的临床对照研究。结果依纳入标准,共包含17个研究,6 299例患者。Meta分析结果显示:与CVCs相比,PICCs置管静脉血栓发生风险升高(OR=2.785,95%CI=1.796~4.321,P0.01),亚组分析提示恶性肿瘤和重症监护患者静脉血栓发生风险均明显升高(恶性肿瘤:OR=3.049,95%CI=1.949~4.770,P0.01;重症监护:OR=3.954,95%CI=2.181~7.168,P0.01)。需治疗人数(NNT)=-30,95%CI=-31.25~-27.78。漏斗图及Egg检验未见明显发表偏倚,敏感性分析显示结果稳定。结论 PICCs高于CVCs相关性静脉血栓的发生风险,尤其对恶性肿瘤和重症监护患者,临床应加强PICCs使用者的血栓筛查。     

封堵治疗与药物治疗卵圆孔未闭隐源性卒中的疗效Meta分析

目的:系统评价卵圆孔封堵治疗与药物治疗隐源性卒中(CS)的疗效与安全性。方法:计算机检索各数据库,纳入关于卵圆孔封堵治疗与药物治疗CS的随机对照研究,进行Meta分析。结果:共纳入10篇文献,包括4 584例患者。与药物治疗相比,PFO封堵治疗后复发性卒中发生率降低(OR 0.47,95%CI 0.33～0.65;异质性P=0.18,I2=29%);两种治疗方案发生TIA风险(OR 1.02,95%CI 0.54～1.94;异质性P=0.03,I2=57%)、出血风险(OR 0.95,95%CI 0.57～1.58;异质性P=0.32,I2=14%)和死亡风险(OR 1.35,95%CI 0.40～4.55;异质性P=0.03,I2=59%)差异均无统计学意义,封堵治疗组新发房颤或房扑的发生率增高(OR 5.73,95%CI 3.08～10.67;异质性P=0.28;I2=20%)。结论:PFO封堵治疗在预防复发性卒中方面优于药物治疗,但封堵治疗可能会增加新发房颤或房扑的发生率。     

微创直接前入路与后外侧小切口入路行初次全髋关节置换术疗效的Meta分析

目的系统评价微创直接前入路(direct anterior approach,DAA)与后外侧小切口入路(posterior lateral approach,PLA)行初次全髋关节置换术的临床疗效。方法计算机检索Cochrane图书馆、中国生物医学数据库、Pubmed、SCI、Embase、维普信息数据库、万方数据库、中国期刊全文数据库CNKI,收集国内外DAA与PLA行初次全髋关节置换术的文献,检索时限为1966年1月至2017年6月。由两名研究者独立进行文献筛选、资料提取和纳入研究的偏倚风险评价后,提取疗效评价相关指标(手术时间、术中出血量、手术切口长度、住院时间及术后并发症、髋关节HHR评分、髋关节脱位情况),采用RevMan5.2软件进行Meta分析。结果共纳入12个研究,总病例数3877例,其中DAA组2085例,PLA组1792例。经Meta分析,与PLA组比较,DAA组手术时间(SMD=1.74、95%CI:1.08~2.40、P<0.000 01)显著增加,术中出血量(SMD=-2.65、95%CI:-4.18~-1.13、P=0.000 7)、手术切口长度(SMD=-1.83、95%CI:-3.36~-0.30、P=0.02)、住院时间(SMD=-1.54、95%CI:-2.28~-0.80、P<0.000 1)、术后髋关节HHR评分(SMD=0.53、95%CI:0.04~1.01、P=0.03)均显著减少;2组术后并发症、髋关节脱位发生率比较差异均无统计学意义(OR=1.06、0.28,95%CI:0.59~1.92、0.07~1.05,P=0.84、0.06)。结论与后外侧小切口入路相比,微创直接前入路行初次全髋关节置换术在术中出血量、手术切口长度、住院时间、术后髋关节HHR评分方面具有明显优势,但在术后并发症与髋关节脱位发生率方面二者无明显差异。     

Comparison of rizatriptan 5 mg and 10 mg tablets and sumatriptan 25 mg and 50 mg tablets

This randomized, double-blind, two-attack, placebo-controlled, crossover study explored the efficacy and tolerability of rizatriptan 10 mg compared with sumatriptan 50 mg as well as rizatriptan 5 mg compared with sumatriptan 25 mg in the acute treatment of migraine. Following randomization to one of six possible treatment sequences, patients (n = 1447) treated two sequential attacks, of moderate or severe intensity, separated by at least 5 days. Patients assessed pain severity, migraine-associated symptoms, and functional disability at 0.5, 1, 1.5, and 2 h post treatment. Compared with placebo, all treatments were effective. On the primary endpoint of time to pain relief, rizatriptan 10 mg was not statistically different from sumatriptan 50 mg [odds ratio (OR) 1.10, P = 0.161], and rizatriptan 5 mg was statistically superior to sumatriptan 25 mg (OR 1.22, P = 0.007). In general, rizatriptan 10 mg and 5 mg treatment resulted in improvement compared with the corresponding doses of sumatriptan on measures of pain severity, migraine symptoms, and functional disability and the 5-mg dose reached statistical significance on almost all measures. All treatments were generally well tolerated.     

Crossover Comparison of Rizatriptan 5 mg and 10 mg Versus Sumatriptan 25 mg and 50 mg in Migraine

Rizatriptan is a selective 5-HT_1B/1D receptor agonist with rapid oral absorption and early onset of action in the acute treatment of migraine. This double-blind, placebo-controlled, crossover study compared rizatriptan 5 mg versus sumatriptan 25 mg, and rizatriptan 10 mg versus sumatriptan 50 mg. A total of 1329 patients were allocated to one of five groups for treatment of two attacks: rizatriptan 5 mg/sumatriptan 25 mg; sumatriptan 25 mg/rizatriptan 5 mg; rizatriptan 10 mg/sumatriptan 50 mg; sumatriptan 50 mg/rizatriptan 10 mg; placebo/placebo. For each attack, patients rated headache severity, presence of associated symptoms, and functional disability prior to dosing and at intervals through 4 hours thereafter. Patients also rated their satisfaction with medication. Rizatriptan 5 mg and 10 mg provided faster relief of headache pain and greater relief of migraine symptoms than the 25-mg and 50-mg doses of sumatriptan, respectively. The response to rizatriptan was better than sumatriptan on additional measures including functional disability and satisfaction with medication. All active treatments were highly effective compared to placebo and acted as early as 30 minutes after dosing. All active treatments were well-tolerated and showed comparable safety profiles.     

Efficacy and safety of eletriptan 20 mg, 40 mg and 80 mg in Japanese migraineurs

This prospective multicentre, double-blind, randomized, parallel-group, placebo-controlled trial evaluated the efficacy and safety of a single dose of eletriptan 20 mg, 40 mg and 80 mg in Japanese migraineurs. A total of 402 adult Japanese migraineurs were diagnosed using International Headache Society (IHS) criteria. At 2 h after a single dose, the headache response rates of eletriptan 20 mg, 40 mg, 80 mg and placebo were 64%, 67%, 76% and 51%, respectively, with all doses significantly superior to placebo ( P <0.05). Eletriptan had a statistically significant dose response for headache relief and pain-free response at 2 h post-dose ( P =0.0011 and P =0.0291, respectively). Most all-causality adverse events were mild and there were no deaths or discontinuations. Saliva samples were used to assess serum eletriptan levels 2 h post-dose. Pharmacokinetic evaluations showed no clinically significant differences between Japanese and Western subjects. Eletriptan was shown to be efficacious, safe, and well tolerated in Japanese migraineurs.     

Comparative efficacy of eletriptan 40 mg versus sumatriptan 100 mg

OBJECTIVE: To confirm the efficacy advantage of eletriptan 40 mg over sumatriptan 100 mg. Background.-Eletriptan 80 mg has demonstrated significantly greater efficacy when compared to both sumatriptan 50 mg and 100 mg in two studies. Eletriptan 40 mg demonstrated significantly greater efficacy than sumatriptan 100 mg in one previous trial. METHODS: Two thousand one hundred thirteen patients with a diagnosis of migraine according to International Headache Society criteria were randomized using a double-blind, double-dummy, parallel-group design, and treated for a single migraine attack with either eletriptan 40 mg, sumatriptan 100 mg, or placebo. The primary endpoint was 2-hour headache response. Secondary endpoints included headache response rates at 1 hour, pain-free rates, absence of associated symptoms, functional response at 1 and 2 hours, and sustained headache response. RESULTS: Headache response rates at 2 hours postdose were significantly higher for eletriptan 40 mg (67%) than for sumatriptan 100 mg (59%; P <.001) and placebo (26%; P <.0001). Eletriptan 40 mg consistently showed significant (P <.01) efficacy over sumatriptan 100 mg across secondary clinical outcomes, including 1-hour headache response; 2-hour pain-free response; absence of nausea, photophobia, and phonophobia; functional improvement; use of rescue medication; treatment acceptability; and sustained headache response (P <.05). Overall, treatment-related adverse events were low, nausea being the only adverse event with an incidence of 2% or higher (4.9% with eletriptan, 4.2% sumatriptan, 2.8% placebo). CONCLUSION: This trial confirmed that eletriptan 40 mg offers superior efficacy in treating migraine pain and associated symptoms and in restoring patient functioning when compared with sumatriptan 100 mg.     

Crossover comparison of rizatriptan 5 mg and 10 mg versus sumatriptan 25 mg and 50 mg in migraine. Rizatriptan Protocol 046 Study Group

Rizatriptan is a selective 5-HT1B/1D receptor agonist with rapid oral absorption and early onset of action in the acute treatment of migraine. This double-blind, placebo-controlled, crossover study compared rizatriptan 5 mg versus sumatriptan 25 mg, and rizatriptan 10 mg versus sumatriptan 50 mg. A total of 1329 patients were allocated to one of five groups for treatment of two attacks: rizatriptan 5 mg/sumatriptan 25 mg; sumatriptan 25 mg/rizatriptan 5 mg; rizatriptan 10 mg/sumatriptan 50 mg; sumatriptan 50 mg/rizatriptan 10 mg; placebo/placebo. For each attack, patients rated headache severity, presence of associated symptoms, and functional disability prior to dosing and at intervals through 4 hours thereafter. Patients also rated their satisfaction with medication. Rizatriptan 5 mg and 10 mg provided faster relief of headache pain and greater relief of migraine symptoms than the 25-mg and 50-mg doses of sumatriptan, respectively. The response to rizatriptan was better than sumatriptan on additional measures including functional disability and satisfaction with medication. All active treatments were highly effective compared to placebo and acted as early as 30 minutes after dosing. All active treatments were well-tolerated and showed comparable safety profiles.     

Initiating warfarin therapy: 5 mg versus 10 mg

OBJECTIVE: To review the literature investigating initial dosing of warfarin at 5 or 10 mg for treatment of acute venous thromboembolism. DATA SOURCES: Articles were identified through searches of MEDLINE (1966-December 2003) using the key words warfarin, oral anticoagulation, warfarin dose, warfarin initiation, venous thromboembolism, and anticoagulation. Additional references were located through review of the bibliographies of the articles cited. STUDY SELECTION AND DATA EXTRACTION: Studies of the initial dosing of warfarin at 5 or 10 mg were evaluated and relevant information was included, as were those that identified known factors that influence the maintenance dose of warfarin. DATA SYNTHESIS: For the treatment of acute venous thromboembolism, warfarin dosing is often provider dependent. Until recently, studies suggested that 5 mg initiation was as effective as 10 mg, without increasing the risk of bleeding. However, the most recent study comparing a 5- versus 10-mg initial dosing nomogram supports an initial dose of 10 mg. These results should be interpreted with caution, however, since patients at high risk for bleeding were excluded from the study. Several patient-specific factors will affect the maintenance dose, guiding clinicians to start with lower (<5 mg) or higher (>5 mg) doses. CONCLUSIONS: Although recent evidence supports a 10-mg initiation nomogram, clinicians should consider patient-specific factors prior to deciding an initial warfarin dose. If a 10-mg loading dose is utilized, strict compliance with the protocol is necessary.     

Discontinuation rates for protease inhibitor regimens containing ritonavir 600 mg versus ritonavir 400 mg plus saquinavir 400 mg.

OBJECTIVE: A retrospective study was performed to determine whether twice-daily ritonavir 400 mg plus twice-daily saquinavir 400 mg (ritonavir 400/saquinavir 400) was better tolerated than ritonavir 600 mg twice daily (ritonavir 600). A secondary objective was to determine whether the rate of discontinuation due to therapeutic failure differed between the two ritonavir regimens. DESIGN: The study was a retrospective chart review. Data collected included ritonavir dose; length of ritonavir therapy; reason for discontinuation; HIV-1 RNA prior to and at discontinuation of ritonavir therapy; CD4+ count; and antiretroviral therapy prior to, concomitant with, and initiated after ritonavir therapy. SETTING: Patient charts were reviewed in a university teaching hospital clinic. PATIENTS: Patients were identified through a search of the pharmacy database from December 18, 1995, to December 18, 1997. Patients were > 18 years old, but not restricted by gender or race. MAIN OUTCOME MEASURES: The main outcome measures were frequency of discontinuation of ritonavir due to intolerance or due to lack of therapeutic efficacy. RESULTS: The search identified 116 patients, including 57 patients taking ritonavir 400/saquinavir 400 and 54 patients taking ritonavir 600. Five patients on other ritonavir regimens were excluded. Significantly fewer patients receiving ritonavir 400/saquinavir 400 (14%) discontinued ritonavir due to intolerance compared with ritonavir 600 (37%; p = 0.002). Discontinuations due to therapeutic failure were not significantly different: 8.8% for ritonavir 400/saquinavir 400 and 7.4% for ritonavir 600, despite the fact that ritonavir/saquinavir therapy followed another protease inhibitor in 41 patients (73.2%) compared with 12 patients (24.5%) for ritonavir 600 (p = 0.001). CONCLUSIONS: Ritonavir 400/saquinavir 400 is better tolerated than ritonavir 600.     

A comparison of preference for and efficacy of tablet formulations of sumatriptan (50 mg and 100 mg), naratriptan (2.5 mg), rizatriptan (10 mg), and zolmitriptan (2.5 mg) in the acute treatment of migraine

Abstract This randomized, multicenter, open-label, five-way crossover study was conducted to assess patients preference for tablet formulations of sumatriptan (50 mg and 100 mg), naratriptan (2.5 mg), rizatriptan (10 mg), and zolmitriptan (2.5 mg) in the acute treatment of migraine and to identify determinants of preference. Patients treated one mild, moderate, or severe migraine with each triptan. The results show that sumatriptan 100 mg was significantly preferred over the random preference rate of 20% (p<0.001) whereas sumatriptan 50 mg, naratriptan, rizatriptan, and zolmitriptan were not. Patients primary reason for preferring a medication was best relief of migraine pain, and the treatment that patients preferred corresponded to the medication that was most likely to confer for them a pain-free response 2 hours postdose. Across all patients, efficacy 2 hours postdose was comparable among triptans with the exception of naratriptan, which was slightly less effective than the other medications (pain-free response 2 hours postdose: 40% sumatriptan 100 mg, 37% sumatriptan 50 mg, 28% naratriptan 2.5 mg, 38% rizatriptan 10 mg, 36% zolmitriptan 2.5 mg). The medications were also similarly well-tolerated. These data demonstrate that information on patients medication preference supplements and does not duplicate data from traditional efficacy measures. Patient preference data are useful in tailoring migraine therapy to the needs of the individual patient.