Venous Thromboembolism Prophylaxis in Inflammatory Bowel Disease Inpatients: Systematic Review and Meta-Analysis.

IF 1.7 4区医学 Q3 HEMATOLOGY

Acta Haematologica Pub Date : 2024-01-01 Epub Date: 2024-03-01 DOI:10.1159/000538086

Rotem McNeil, Danielle Fredman, Ofir Eldar, Anat Gafter-Gvili, Tomer Avni

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引用次数: 0

Abstract

Introduction: Inflammatory bowel disease (IBD) patients are three times more likely to develop venous thromboembolism (VTE), and guidelines recommend prophylaxis during all hospitalizations. In this systematic review, we sought to assess for the benefits and risks of VTE prophylaxis in hospitalized IBD patients.

Methods: We performed a systematic review and meta-analysis. We searched MEDLINE and others up to 2/2022, for studies on IBD inpatients treated with prophylactic anticoagulation during hospitalization, compared to no prophylaxis. Primary efficacy and safety outcomes were any VTE and major bleeding, respectively. Results were pooled using random-effects models, calculating odds ratios (OR), and 95% confidence intervals (CI). The ROBINS-I tool was used to assess bias.

Results: We extracted data from 18 observational studies and 2 randomized-trial subgroups. The studies were highly variable regarding the included populations, interventions, and outcome definitions. Meta-analysis of all studies showed a nonsignificant effect of prophylaxis on VTEs (OR: 0.97 [95% CI: 0.49-1.95]). An analysis of eight lower-risk-of-bias studies showed a significant reduction in VTEs (OR: 0.27 [95% CI: 0.13-0.55], number needed to treat (NNT) 34.8 [95% CI: 26.8-49.8]). A significant protective effect persisted in several subgroups. Major bleeding was reported in three studies and showed a significant increase with prophylaxis (OR: 2.02 [95% CI: 1.11-3.67], number needed to harm (NNH) 113.6 [95% CI: 40.7-very-large-number]).

Conclusion: In studies with lower-risk-of-bias, a significant reduction in VTEs was shown in patients treated with VTE prophylaxis (NNT = 35), which should be carefully considered against an increased major-bleeding risk (NNH = 114). However, current data are limited and randomized trials dedicated to IBD inpatients would aid in understating whether universal prophylaxis should be recommended.

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炎症性肠病患者的静脉血栓栓塞预防 - 系统回顾和荟萃分析。

导言：炎症性肠病（IBD）患者发生静脉血栓栓塞症（VTE）的几率是普通人的三倍，因此指南建议所有住院患者都应进行预防。在本系统综述中，我们试图评估住院 IBD 患者预防 VTE 的益处和风险：我们进行了系统回顾和荟萃分析。我们检索了截至 2022 年 2 月的 MEDLINE 和其他文献，以获得关于住院期间接受预防性抗凝治疗的 IBD 患者与未接受预防性治疗的患者的对比研究。主要疗效和安全性结果分别为任何 VTE 和大出血。采用随机效应模型对结果进行了汇总，计算出了几率比（OR）和95%置信区间（CI）。采用 ROBINS-I 工具评估偏倚：我们从 18 项观察性研究和两项随机试验分组中提取了数据。这些研究在纳入人群、干预措施和结果定义方面存在很大差异。对所有研究进行的 Meta 分析表明，预防性治疗对 VTE 的影响不显著（OR 0.97[95%CI 0.49-1.95]）。对八项偏倚风险较低的研究进行的分析表明，预防性治疗可显著降低 VTE 的发生率（OR 0.27[95%CI 0.13-0.55]，治疗需要量（NNT）34.8[95%CI 26.8-49.8]）。在几个亚组中仍存在明显的保护作用。有三项研究报告了大出血，并显示预防性治疗的效果显著增加（OR 2.02[95%CI 1.11-3.67]，需要治疗的人数（NNH）113.6[95%CI 40.7-极大量]）：结论：在偏倚风险较低的研究中，接受 VTE 预防治疗的患者 VTE 病例显著减少（NNT=35），但应仔细考虑这与增加的大出血风险（NNH=114）之间的关系。然而，目前的数据有限，专门针对 IBD 住院患者的随机试验将有助于了解是否应推荐普遍预防。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Haematologica 医学-血液学

CiteScore

4.90

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： ''Acta Haematologica'' is a well-established and internationally recognized clinically-oriented journal featuring balanced, wide-ranging coverage of current hematology research. A wealth of information on such problems as anemia, leukemia, lymphoma, multiple myeloma, hereditary disorders, blood coagulation, growth factors, hematopoiesis and differentiation is contained in first-rate basic and clinical papers some of which are accompanied by editorial comments by eminent experts. These are supplemented by short state-of-the-art communications, reviews and correspondence as well as occasional special issues devoted to ‘hot topics’ in hematology. These will keep the practicing hematologist well informed of the new developments in the field.