Esther Barbero Herranz, C. Coscia, Ana Jaureguizar, C. A. Quezada, A. Muriel, M. Monreal, T. Villén, D. Chiluiza, Joger Yusen, D. Jiménez
{"title":"通过临床试验和观察性研究评估血栓栓塞性静脉疾病治疗的有效性","authors":"Esther Barbero Herranz, C. Coscia, Ana Jaureguizar, C. A. Quezada, A. Muriel, M. Monreal, T. Villén, D. Chiluiza, Joger Yusen, D. Jiménez","doi":"10.1183/13993003.congress-2019.pa3651","DOIUrl":null,"url":null,"abstract":"It is unknown whether the efficacy of treatments for venous thromboembolic disease (VTE) estimated by observational studies with propensity analysis is similar to the one estimated by clinical trials (ECs). A systematic review of PubMed and Web of Science was conducted to identify observational studies with propensity analysis that would have evaluated the effect of VTE treatments on short term all-cause mortality. After identifying the treatment scenarios evaluated by the observational studies, a standardized algorithm was used to match them with at least one CE or a meta-analysis of ECs. The efficacy of the treatment (relative odds ratio [OR]) between the observational studies and the paired Ecs was compared. The global relative OR for all clinical scenarios was also calculated. Results: observational studies and CSs evaluated 7 treatment scenarios for VTE. There was no statistically significant difference in the effect on mortality obtained by observational studies compared to CSs (OR 0.89 [95%CI,0.32-1.46]). However, in 2 scenarios (thrombolysis vs. anticoagulation for lung thromboembolism, treatment with enoxaparin once or twice a day for VTE) there were statistically significant differences in the direction of effect, and there were no significant differences in the magnitude of the effect in 2 other scenarios (rivaroxaban vs. vitamin K antagonists for the treatment of VTE, home treatment vs. hospitalization for deep vein thrombosis). Conclusions: observational studies that use propensity analysis and CSs find similar results regarding the effect of VTE treatments, although there are occasionally differences in the direction/magnitude of this effect.","PeriodicalId":20797,"journal":{"name":"Pulmonary embolism","volume":"13 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effectiveness of the tromboembolic venous disease treatments estimated through clinical trials vs. observational studies\",\"authors\":\"Esther Barbero Herranz, C. Coscia, Ana Jaureguizar, C. A. Quezada, A. Muriel, M. Monreal, T. Villén, D. Chiluiza, Joger Yusen, D. Jiménez\",\"doi\":\"10.1183/13993003.congress-2019.pa3651\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"It is unknown whether the efficacy of treatments for venous thromboembolic disease (VTE) estimated by observational studies with propensity analysis is similar to the one estimated by clinical trials (ECs). A systematic review of PubMed and Web of Science was conducted to identify observational studies with propensity analysis that would have evaluated the effect of VTE treatments on short term all-cause mortality. After identifying the treatment scenarios evaluated by the observational studies, a standardized algorithm was used to match them with at least one CE or a meta-analysis of ECs. The efficacy of the treatment (relative odds ratio [OR]) between the observational studies and the paired Ecs was compared. The global relative OR for all clinical scenarios was also calculated. Results: observational studies and CSs evaluated 7 treatment scenarios for VTE. There was no statistically significant difference in the effect on mortality obtained by observational studies compared to CSs (OR 0.89 [95%CI,0.32-1.46]). However, in 2 scenarios (thrombolysis vs. anticoagulation for lung thromboembolism, treatment with enoxaparin once or twice a day for VTE) there were statistically significant differences in the direction of effect, and there were no significant differences in the magnitude of the effect in 2 other scenarios (rivaroxaban vs. vitamin K antagonists for the treatment of VTE, home treatment vs. hospitalization for deep vein thrombosis). Conclusions: observational studies that use propensity analysis and CSs find similar results regarding the effect of VTE treatments, although there are occasionally differences in the direction/magnitude of this effect.\",\"PeriodicalId\":20797,\"journal\":{\"name\":\"Pulmonary embolism\",\"volume\":\"13 1\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2019-09-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pulmonary embolism\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1183/13993003.congress-2019.pa3651\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pulmonary embolism","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1183/13993003.congress-2019.pa3651","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目前尚不清楚通过倾向分析的观察性研究估计的治疗静脉血栓栓塞性疾病(VTE)的疗效是否与临床试验(ECs)估计的疗效相似。对PubMed和Web of Science进行了系统回顾,以确定观察性研究,并进行倾向分析,以评估静脉血栓栓塞治疗对短期全因死亡率的影响。在确定观察性研究评估的治疗方案后,使用标准化算法将其与至少一个CE或ec的荟萃分析相匹配。比较观察性研究和配对Ecs之间的治疗效果(相对优势比[OR])。还计算了所有临床情况的全局相对OR。结果:观察性研究和CSs评估了静脉血栓栓塞的7种治疗方案。与CSs相比,观察性研究对死亡率的影响无统计学差异(OR 0.89 [95%CI,0.32-1.46])。然而,在2种情况下(溶栓vs抗凝治疗肺血栓栓塞,静脉血栓栓塞用依诺肝素治疗1 - 2天),效果的方向有统计学意义的差异,而在其他2种情况下(利伐沙班vs维生素K拮抗剂治疗静脉血栓,家庭治疗vs深静脉血栓住院治疗),效果的大小没有显著差异。结论:使用倾向分析和CSs的观察性研究发现关于静脉血栓栓塞治疗效果的相似结果,尽管这种效果的方向/幅度偶尔存在差异。
Effectiveness of the tromboembolic venous disease treatments estimated through clinical trials vs. observational studies
It is unknown whether the efficacy of treatments for venous thromboembolic disease (VTE) estimated by observational studies with propensity analysis is similar to the one estimated by clinical trials (ECs). A systematic review of PubMed and Web of Science was conducted to identify observational studies with propensity analysis that would have evaluated the effect of VTE treatments on short term all-cause mortality. After identifying the treatment scenarios evaluated by the observational studies, a standardized algorithm was used to match them with at least one CE or a meta-analysis of ECs. The efficacy of the treatment (relative odds ratio [OR]) between the observational studies and the paired Ecs was compared. The global relative OR for all clinical scenarios was also calculated. Results: observational studies and CSs evaluated 7 treatment scenarios for VTE. There was no statistically significant difference in the effect on mortality obtained by observational studies compared to CSs (OR 0.89 [95%CI,0.32-1.46]). However, in 2 scenarios (thrombolysis vs. anticoagulation for lung thromboembolism, treatment with enoxaparin once or twice a day for VTE) there were statistically significant differences in the direction of effect, and there were no significant differences in the magnitude of the effect in 2 other scenarios (rivaroxaban vs. vitamin K antagonists for the treatment of VTE, home treatment vs. hospitalization for deep vein thrombosis). Conclusions: observational studies that use propensity analysis and CSs find similar results regarding the effect of VTE treatments, although there are occasionally differences in the direction/magnitude of this effect.