直接Xa因子抑制剂预防全膝关节置换后深静脉血栓的Meta分析

背景：直接Xa因子抑制剂开始在预防和治疗血栓方面发挥重要作用,与低分子量肝素相比其在预防全膝关节置换后血栓形成中的疗效与安全性尚不清楚。 目的：探讨直接Xa因子抑制剂和低分子量肝素预防全膝关节置换后深静脉血栓的优劣。 方法：电子检索MEDLINE,EMBASE,Cochrane图书馆、CBM,CNKI等数据库,并辅以手工检索,全面查找国内外比较直接Xa因子抑制剂和低分子量肝素预防全膝关节置换后深静脉血栓的随机对照试验。根据Cochrane手册提出的文献质量评价标准对纳入研究进行质量评价,并应用统计软件Stata12.0进行数据分析。 结果与结论：直接Xa因子抑制剂较低分子量肝素可显著降低全膝关节置换患者症状性深静脉血栓发生率(P < 0.05),且不增加出血风险,2组患者肺栓塞和随访期内死亡率差异无显著性意义(P > 0.05)。提示在全膝关节置换后深静脉血栓的预防中,直接Xa因子抑制剂较低分子量肝素更加安全、有效和方便。

Direct factor Xa inhibitors prevent deep venous thromboembolism after total knee arthroplasty: A Meta-analysis

BACKGROUND:Direct factor Xa inhibitors play an important role in the prevention and treatment of venous thromboembolism. However, the efficacy and safety of direct factor Xa inhibitors in the prevention of venous thromboembolism in the patients that undergoing total knee arthroplasty is not clear when compared with the low-molecular-weight heparin. OBJECTIVE:To explore the pros and cons of direct factor Xa inhibitor and low-molecular-weight heparin in the prevention of deep venous thromboembolism after total knee arthroplasty. METHODS:A computer-based online search was performed in MEDLINE database, EMBASE database, Cochrane Library, CBM database and CNKI database, supplemented by manual searches to find the randomized trials on the comparison of direct factor Xa inhibitor and low-molecular-weight heparin in the prevention of deep venous thromboembolism after total knee arthroplasty. The quality of included studies was evaluated by quality assessment standards proposed by the Cochrane Handbook, and data analysis was performed with Stata12.0 software. RESULTS AND CONCLUSION:Compared with low-molecular-weight heparin, direct factor Xa inhibitor can significantly reduce the incidence of symptomatic deep venous thromboembolism without increasing bleeding risk (P < 0.05), and there were no significant differences in mortality rate during follow-up period and pulmonary embolism between two groups (P > 0.05). In the prevention of deep venous thromboembolism after total knee arthroplasty, direct factor Xa inhibitor is more secure, effective and convenient than low-molecular-weight heparin.