在癌症和非癌症患者中非维生素K拮抗剂口服抗凝药的相对效益分析:随机对照试验的Meta分析

王晨曦; 杨萍萍; 李忠城; 邬涛; 吴清华

doi:10.13201/j.issn.1001-1439.2020.01.014

在癌症和非癌症患者中非维生素K拮抗剂口服抗凝药的相对效益分析:随机对照试验的Meta分析

- 南昌大学第二附属医院心血管内科(南昌, 330006)
基金项目:
国家自然科学基金项目(No:81860068)

详细信息

通讯作者: 吴清华,E-mail:ncwqh@163.com

中图分类号: R541.7

收稿日期: 2019-08-30

Comparison of relative benefits of non-vitamin K antagonist oral anticoagulants between cancer patients and ordinary patients: a meta-analysis of randomized controlled trials

- Department of Cardiology, the Second Hospital Affiliated to Nanchang University, Nanchang, 330006, China

More Information

Corresponding author: WU Qinghua, E-mail: ncwqh@163.com

Received Date: 30 August 2019

摘要

摘要: 目的:探讨非维生素K拮抗剂(NOACs)和传统维生素K拮抗剂(VKAs)在癌症患者和非癌症患者中预防和治疗血栓性疾病时的相对有效性和安全性。方法:对PubMed、Web of Science、Embase和Clinical Trials电子数据库进行检索,不设语言限制,检索时限为2019年7月之前。将所有NOACs数据合并,计算血栓性疾病和大出血事件的相对风险(RRs)和95%置信区间(CIs)。结果:共纳入9篇随机对照试验(RCTs),包含80 666例患者,其中非癌症患者74 353例,癌症患者6 313例。荟萃分析结果提示,在癌症患者中,NOACs相对于VKAs可显著减少血栓栓塞(RR 0.69,95%CI 0.54~0.88)和大出血(RR 0.76,95%CI 0.62~0.93)事件;在非癌症患者中,NOACs相对于VKAs可显著减少大出血事件(RR 0.68,95%CI 0.54~0.86),但在血栓栓塞性事件上无明显差别(RR 1.02,95%CI 0.90~1.15)。结论:在癌症患者中,NOACs的相对有效性表现得更加明显,但无论对于癌症还是非癌症患者,相比于VKAs,NOACs可能是更好的选择。
- 非维生素K拮抗剂 /
- 癌症 /
- 血栓性疾病 /
- 大出血
Abstract: Objective:To explore that the relative efficacy and safety of new oral non-vitamin K oral antagonists(NOACs) and traditional vitamin K oral antagonists(VKAs) in the prevention and treatment of thrombotic diseases in cancer patients and non-cancer patients.Method:We searched electronic databases such as PubMed,Web of Science,Embase and Clinical Trials,without language restrictions,until June 2019.We pooled data of all NOACs,and calculated relative risks(RRs) and 95% confidence intervals(CIs) of each outcomes.Result:A total of 9 studies were included,including 80 666 patients,of whom 6 313 cancer patients and 74 353 non-cancer patients.Resultsof the meta-analysis suggested that in cancer patients,NOACs significantly reduced thromboembolic events(RR 0.69,95%CI 0.54-0.88) and major bleeding events(RR 0.76,95%CI 0.62-0.93) compared with VKAs.In non-cancer patients,NOACs significantly reduced major bleeding events compared with VKAs(RR 0.68,95%CI 0.54-0.86),but there was no significant difference in thromboembolic events(RR 1.02,95%CI 0.90-1.15).Conclusion:The relative effectiveness of NOACs is more pronounced in cancer patients,but may be a better choice than VKAs for both cancer and non-cancer patients.
- non-vitamin K oral antagonists /
- cancer /
- thrombotic disease /
- major bleeding

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参考文献(25)

[1]	Lin JT.Thromboembolic events in the cancer patient[J].J Womens Health,2003,12:541-551.
[2]	Farmakis D,Parissis J,Filippatos G.Insights into onco-cardiology:atrial fibrillation in cancer[J].J Am Coll Cardiol,2014,63(10):945-953.
[3]	Mant J,Hobbs FD,Fletcher K,et al.Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study,BAFTA):a randomised controlled trial [J].Lancet,2007,370(9586):493-503.
[4]	Lee YJ,Park JK,Uhm JS,et al.Bleeding risk and major adverse events in patients with cancer on oral anticoagulation therapy[J].Int J Cardiol,2016,203:372-378.
[5]	Posch F,Konigsbrugge O,Zielinski C,et al.Treatment of venous thromboembolism in patients with cancer:a network meta-analysis comparing efficacy and safety of anticoagulants[J].Thromb Res,2015,136(3):582-589.
[6]	Giugliano RP,Ruff CT,Braunwald E,et al.Edoxaban vs warfarin in patients with atrial fibrillation[J].N Engl J Med,2013,369:2093-2104.
[7]	陈志坚,易桂文.2016年ESC心房颤动管理指南更新解读[J].临床心血管病杂志,2016,32(11):1076-1078.
[8]	赵丹,周鹏.冠心病合并心房颤动患者PCI术后两联与三联抗栓治疗安全性和有效性的meta分析[J].临床心血管病杂志,2019,35(3):210-214.
[9]	Lip GY,Andreotti F,Fauchier L,et al.Bleeding risk assessment and management in atrial fibrillation patients:a position document from the European Heart Rhythm Association,endorsed by the European Society of Cardiology Working Group on Thrombosis[J].Europace,2011,13(5):723-746.
[10]	李忠城,苏建,李菊香.经导管主动脉瓣置换术对于外科低危主动脉瓣狭窄患者有效性和安全性的Meta分析[J].临床心血管病杂志,2019,35(9):835-841.
[11]	Agnelli G,Buller HR,Cohen A,et al.Oral apixaban for the treatment of venous thromboembolism in cancer patients:results from the AMPLIFY trial[J].J thromb Haemost,2015,13(12):2187-2191.
[12]	Raskob GE,van Es N,Segers A,et al.Edoxaban for venous thromboembolism in patients with cancer:results from a non-inferiority subgroup analysis of the Hokusai-VTE randomised,double-blind,double-dummy trial[J].Lancet Haematol,2016,3(8):e379-387.
[13]	Chen ST,Hellkamp AS,Becker RC,et al.Efficacy and safety of rivaroxaban vs.warfarin in patients with non-valvular atrial fibrillation and a history of cancer:observations from ROCKET AF[J].Eur Heart J Qual Care Clin Outcomes,2019,5(2):145-152.
[14]	Melloni C,Dunning A,Granger CB,et al.Efficacy and safety of apixaban versus warfarin in patients with atrial fibrillation and a history of cancer:insights from the ARISTOTLE Trial[J].Am J Med,2017,130(12):1440-1448.
[15]	Fanola MD,Ruff MD,Sabina A,et al.Efficacy and safety of Edoxaban in patients with active alignancy and atrial fibrillation:analysis of the ENGAGE AF-TIMI 48 Trial[J].J Am Heart Assoc,2018,7(16):e008987.
[16]	The EINSTEIN Investigators.Oral rivaroxaban for symptomatic venous thromboembolism[J].N Engl J Med,2010,363(26):2499-510.
[17]	The EINSTEIN-PE Investigators.Oral rivaroxaban for the treatment of symptomatic pulmonary mbolism[J].N Engl J Med,2012,366(14):1287-1297.
[18]	Schulman S,Kearon C,Kakkar AK,et al.Dabigatran versus warfarin in the treatment of acute venous thromboembolism[J].N Engl J Med,2009,361(24):2342-2352.
[19]	Schulman S,Kakkar AK,Goldhaber SZ,et al.Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis[J].Circulation,2014,129(7):764-772.
[20]	Ruff CT,Giugliano RP,Braunwald E,et al.Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation:a meta-analysis of randomised trials[J].Lancet,2014,383(9921):955-962.
[21]	Comerota AJ,Ramaccioyyi E.A comprehensive overview of direct oral anticoagulants for the management of venous thromboembolism[J].Am J Med Sci,2016,352(1):92-106.
[22]	Kearon C,Akl EA,Ornelas J,et al.Antithrombotic therapy for VTE disease:CHEST guideline and expert panel report[J].Chest,2016,149(2):315-352.
[23]	Patel HK,Khorana AA.Anticoagulation in cancer patients:a summary of pitfalls to avoid[J].Curr Oncol Rep,2019;21(2):18.
[24]	Xiang E,Ahuja T,Raco V,et al.Anticoagulation prescribing patterns in patients with cancer[J].J Thromb Thrombolysis,2018,45(1):89-98.
[25]	Young AM,Marshall A,Thirlwall J,et al.Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism:results of a randomized trial (SELECT-D)[J].J Clin Oncol,2018,36(20):2017-2023.