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17 212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。

Dabigatran and rivaroxaban versus enoxaparin for anticoagulant therapy after total knee or hip arthroplasty

BACKGROUND:The enoxaparin is commonly used in clinic to prevent venous thrombosis after total hip or total knee replacement, but it is not 100% effective and safe.OBJECTIVE:To systematically evaluate the efficacy and safety of dabigatran and rivaroxaban versus enoxaparin in preventing venous thrombosis after total knee or hip arthroplasty in the clinical randomized controlled trials.METHODS:A computer-based online search of PubMed database, ScienceDirect database, Cochrane Library, CBM database and CNKI database was performed for the randomized controlled trials on efficacy and safety of dabigatran and rivaroxaban versus enoxaparin for anticoagulant therapy after total knee or hip arthroplasty. The methodological quality of included studies was evaluated, and the statistical software was RevMan5.1.0.RESULTS AND CONCLUSION:A total of 14 randomized controlled trials including 17 212 patients were included. Meta-analysis showed that the incidences of total vein thrombosis, large vein thrombosis and symptomatic vein thrombosis in the rivaroxaban group were lower than those in the enoxaparin group; the incidence of deep vein thrombosis in the rivaroxaban group and dabigatran group was lower than that in the enoxaparin group; there was significant difference of incidence of deep vein thrombosis between rivaroxaban group, dabigatran group and dabigatran group. It indicates that the effect of new oral anticoagulants for the prevention of deep vein thrombosis after total hip or total knee arthroplasty is superior to enoxaparin, and rivaroxaban is better than dabigatran.