中国循证医学杂志

中国循证医学杂志

导管溶栓与单纯抗凝比较治疗深静脉血栓形成疗效和安全性的 Meta 分析

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目的系统评价导管溶栓(catheter-directed thrombolysis,CDT)对比单纯抗凝(anticoagulation,AC)治疗深静脉血栓形成(deep vein thrombosis,DVT)的疗效与安全性。 方法计算机检索 PubMed、EMbase、The Cochrane Library、Web of Science、WanFang Data 和 CNKI 数据库,搜集关于 CDT 与 AC 比较治疗 DVT 的随机对照试验(RCT),检索时限均从建库至 2018 年 3 月。由 2 位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用 RevMan 5.3 软件进行 Meta 分析。 结果共纳入 5 个 RCT,共 989 例患者。Meta 分析结果显示:CDT 组患者的血栓后综合征(post-thrombotic syndrome,PTS)发生率[RR=0.73,95%CI(0.49,1.09),P=0.13]、髂股静脉通畅率[RR=2.57,95%CI(0.59,11.24),P=0.21]、出血事件发生率[RR=2.03,95%CI(0.50,8.28),P=0.32]、严重出血事件发生率[RR=1.77,95%CI(0.91,3.42),P=0.09]、静脉血栓栓塞症(venous thromboembolism,VTE)复发率[RR=1.00,95%CI(0.42,2.36),P=0.99]与 AC 组相比差异均无统计学意义,但中重度 PTS 发生率较 AC 组更低[RR=0.70,95%CI(0.53,0.92),P=0.01]。 结论CDT 与 AC 治疗相比并不能降低患者的 PTS 发生率和 VTE 复发率,不能提高患者髂股静脉的远期通畅率,但对于中重度 PTS 的发生有一定预防作用。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

ObjectivesTo systematically review the efficacy and safety of catheter-directed thrombolysis (CDT) versus anti-coagulation (AC) for deep vein thrombosis (DVT). MethodsWe searched PubMed, EMbase, The Cochrane Library, Web of Science, WanFang Data and CNKI databases to collect randomized clinical trials (RCTs) about CDT versus AC for DVT from inception to March 2018. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 5 RCTs and 989 patients were included. Meta-analysis showed that there was no significant difference between the two group in incidence of post-thrombotic syndrome (RR=0.73, 95%CI 0.49 to 1.09, P=0.13), iliofemoral venous patency rate (RR=2.57, 95%CI 0.59 to 11.24, P=0.21), bleeding (RR=2.03, 95%CI 0.50 to 8.28, P=0.32), severe bleeding (RR=1.77, 95%CI 0.91 to 3.42, P=0.09) and recurrence rate of venous thromboembolism (RR=1.00, 95%CI 0.42 to 2.36, P=0.99). However, the incidence of moderate-severe PTS decreased in CDT group was lower than that in the control group (RR=0.70, 95%CI 0.53 to 0.92, P=0.01). ConclusionsCompared with the control group, catheter-directed thrombolysis does not reduce the incidence of PTS and VTE recurrence rate, cannot improve the long-term patency of the iliofemoral vein, yet can prevent the occurrence of moderate to severe PTS. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

关键词: 深静脉血栓形成; 导管溶栓; 血栓后综合征; 随机对照试验; Meta 分析

Key words: Deep vein thrombosis; Catheter-directed thrombolysis; Post-thrombotic Syndrome; RCT; Meta-analysis

引用本文: 王浩然, 高涌. 导管溶栓与单纯抗凝比较治疗深静脉血栓形成疗效和安全性的 Meta 分析. 中国循证医学杂志, 2018, 18(9): 953-957. doi: 10.7507/1672-2531.201803057 复制

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