肿瘤手术后药物血栓预防持续时间延长:随机对照试验的系统回顾和荟萃分析

IF 3.4 3区 医学 Q1 HEMATOLOGY
Zhongwang Wang , Zhengyu Yu , Ting Niu
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引用次数: 0

摘要

背景静脉血栓栓塞(VTE)是术后30天死亡率的主要原因,尽管目前的指南建议延长血栓预防时间,但其对临床有意义的益处的影响证据有限。目的通过随机对照试验(RCTs)的荟萃分析,评价癌症手术患者长期抗凝预防与仅住院预防的疗效和安全性。方法对10项随机对照试验进行系统评价和荟萃分析。主要结局包括总静脉血栓栓塞、症状性静脉血栓栓塞、肺栓塞(PE)、大出血和全因死亡率。采用相对比(RR)和95%置信区间(ci)对结果进行总结。结果延长预防可显著降低30天内静脉血栓栓塞发生率(4.0% vs 10.0%; RR 0.40, 95% CI 0.22-0.76)。在30天症状性静脉血栓栓塞发生率(0.7%对1.1%;RR 0.66, 95% CI 0.29-1.48)、PE(0.5%对0.5%)或90天死亡率(1.4%对1.6%)方面均无显著差异。大出血发生率无显著增加(0.9% vs. 0.2%; RR 2.37, 95% CI 0.79-7.11)。亚组分析显示,基于手术部位的主要结局存在异质性(腹盆腔与胸外科)。结论:虽然延长药物血栓预防治疗的时间可以降低静脉血栓栓塞的总发生率,但对于症状事件或生存并没有临床意义的益处。目前的风险分层工具可能高估了接受标准住院预防的癌症手术患者的血栓形成风险。我们的研究结果支持选择性的,而不是普遍的,长期预防的方法,强调个体化的风险评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Prolonged duration of pharmacological thromboprophylaxis following oncologic surgery: A systematic review and meta-analysis of RCTs

Prolonged duration of pharmacological thromboprophylaxis following oncologic surgery: A systematic review and meta-analysis of RCTs

Background

Venous thromboembolism (VTE) is the leading cause of 30-day postoperative mortality, with current guidelines recommending extended-duration thromboprophylaxis despite limited evidence on its impact on clinically meaningful benefits.

Objective

To evaluate the efficacy and safety of prolonged anticoagulant prophylaxis versus in-hospital only prophylaxis in cancer surgery patients using a meta-analysis of randomized controlled trials (RCTs).

Methods

We conducted a systematic review and meta-analysis of 10 RCTs. The primary outcomes included overall VTE, symptomatic VTE, pulmonary embolism (PE), major bleeding, and all-cause mortality. Results were summarized using relative ratios (RR) and 95 % confidence intervals (CIs).

Results

Prolonged prophylaxis significantly reduced the 30-day incidence of overall VTE (4.0 % vs. 10.0 %; RR 0.40, 95 %CI 0.22–0.76). No significant differences were observed in the 30-day incidence of symptomatic VTE (0.7 % vs. 1.1 %; RR 0.66, 95 %CI 0.29–1.48), PE (0.5 % vs. 0.5 %), or 90-day mortality (1.4 % vs. 1.6 %). A non-significant increase in major bleeding occurred (0.9 % vs. 0.2 %; RR 2.37, 95 %CI 0.79–7.11). Subgroup analyses indicated heterogeneity in primary outcomes based on surgical site (abdominopelvic vs. thoracic surgery).

Conclusion

While prolonged duration of pharmacological thromboprophylaxis reduces the incidence of overall VTE, it does not demonstrate clinically meaningful benefits for symptomatic events or survival. Current risk-stratification tools may overestimate thrombotic risk in cancer surgery patients receiving standard in-hospital prophylaxis. Our findings support a selective, rather than universal, approach to prolonged prophylaxis, emphasizing individualized risk assessment.
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来源期刊
Thrombosis research
Thrombosis research 医学-外周血管病
CiteScore
14.60
自引率
4.00%
发文量
364
审稿时长
31 days
期刊介绍: Thrombosis Research is an international journal dedicated to the swift dissemination of new information on thrombosis, hemostasis, and vascular biology, aimed at advancing both science and clinical care. The journal publishes peer-reviewed original research, reviews, editorials, opinions, and critiques, covering both basic and clinical studies. Priority is given to research that promises novel approaches in the diagnosis, therapy, prognosis, and prevention of thrombotic and hemorrhagic diseases.
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