7种新型口服抗凝药预防全髋、膝关节置换术后静脉血栓栓塞症的网状Meta分析

目的 采用网状Meta分析法，比较7种新型口服抗凝药预防全髋、膝关节置换术后静脉血栓栓塞症作用的有效性。方法 检索CBM、Cochrane Library、Pubmed等数据库，从中提取随机对照试验，进行质量评价。应用软件Stata12.0，采用mvmeta程序包分析数据。结果 检索相关文献1 091篇，24篇符合标准，共计40 001例患者；按处方药物用量评价预防静脉血栓栓塞症的有效性。直接比较结果：利伐沙班、阿哌沙班优于低分子肝素，结果分别为：RR=0.56，95% CI：0.40~0.78，P<0.05；RR=0.39，95% CI：0.24~0.63，P<0.05。其余5种新型口服抗凝药与低分子肝素比较无显著差别（P>0.05）。间接比较，结果均优于安慰剂。结论 7种新型口服抗凝药预防全髋、膝关节置换术后静脉血栓栓塞症的有效性等级排名：阿哌沙班最佳，其次为利伐沙班、依度沙班、Ym150、TAK-442、达比加群酯、贝曲沙班。

Seven kinds of new oral anticoagulants for prevention of venous thromboembolism after total hip or knee arthroplasty: a net Meta-analysis

Objective To assess the efficacy of seven kinds of new oral anticoagulants in prevention of venous thromboembolism in patients after total hip or knee replacement by a network Meta-analysis.Methods Randomized clinical trials in databases of CBM,Cochrane Library,Pubmed were searched. The quality of the included studies was assessed. Data were analyzed by Stata12.0 software,and mvmeta program package.Results 24 RCTs (in all 1 091 articles,40 001 patients) met the criteria. Prevention for VTE with prescribed dosage was evaluated. Following findings,directly,Rivaroxaban and Apixaban were more effective than low molecular weight heparin,results as (RR=0.56,95%CI:0.40-0.78),P<0.05;(RR=0.39,95%CI:0.24-0.63),P<0.05. The others compared with LMWH,P>0.05,had no statistical significance. Indirectly,these were all superior efficacy to placebo.Conclusion Grade rankings of efficacy for seven kinds of NOACs prevented VTE in patients after THR or TKR,Apixaban was best,followed by Rivaroxaban,Edoxaban,Ym150,TAK-442,dabigatran etexilate,Betrixaban.