肺癌患者静脉血栓栓塞预防的疗效与安全性的meta分析

doi:10.5246/jcps.2023.10.069

中国药学(英文版) ›› 2023, Vol. 32 ›› Issue (10): 852-860.DOI: 10.5246/jcps.2023.10.069

• 【药事管理与临床药学专栏】 • 上一篇下一篇

肺癌患者静脉血栓栓塞预防的疗效与安全性的meta分析

苏俐玫¹, 毛溪悦¹, 阳丽梅²^,^*()

1. 福建医科大学基础医学院, 福建福州 350000
2. 福建医科大学省立临床医学院福建省立医院药学部, 福建福州 350000

收稿日期:2023-03-24 修回日期:2023-04-29 接受日期:2023-05-19 出版日期:2023-11-04 发布日期:2023-11-04
通讯作者: 阳丽梅
作者简介:
+ Tel.: +86-591-88216353, E-mail: yanglimei_214@163.com
基金资助:
Fujian Medical University (Grant No. 2017XQ010); and Medical Science Research Fund of Beijing Medical and Health Foundation (Grant No. B183023).

Efficacy and safety of venous thromboembolism prevention in lung cancer: a meta-analysis of randomized controlled studies

Limei Su¹, Xiyue Mao¹, Limei Yang²^,^*()

1 School of Basic Medical Sciences of Fujian Medical University, Fuzhou 350000, Fujian, China
2 Department of Pharmacy, Provincial Clinical College of Fujian Medical University/Fujian Provincial Hospital, Fuzhou 350001, Fujian, China

Received:2023-03-24 Revised:2023-04-29 Accepted:2023-05-19 Online:2023-11-04 Published:2023-11-04
Contact: Limei Yang

摘要/Abstract

摘要：

静脉血栓栓塞(VTE)是肺肿瘤患者的重要并发症和死亡风险之一。抗凝治疗在预防静脉血栓栓塞中起着重要作用, 但其在肺癌患者中预防静脉血栓栓塞的安全性和有效性尚未得到系统评估。本研究旨在对肺癌患者预防性使用抗凝治疗的有效性和安全性进行meta分析。对于2020年9月之前发表在Pubmed, Embase, 中国知网 (CNKI)和万方数据库上的文献进行系统性检索, 根据纳入标准和排除标准对文献进行筛选, 采用改良Jadad量表对纳入文献进行质量评价, 利用Review Manager 5.4软件进行meta分析。对2272篇文献进行筛选, 最后纳入4项研究, 均为随机对照研究。质量评价结果显示有两篇为高质量文献 (≥ 4分), 其余文献得分均 ≤ 3分, 属低质量文献研究。所有文献Jadad平均得分为3.5分。Meta分析结果显示, 抗凝治疗可以显著降低肺癌患者VTE的发生率[RR = 0.55, 95% CI (0.43, 0.70), P < 0.00001], 且患者总出血发生率[RR = 1.74, 95% CI (0.87, 3.50), P = 0.12], 一般出血发生率[RR = 1.64, 95% CI (0.66, 4.05), P = 0.29], 大出血发生率[RR = 1.70, 95% CI (0.91, 3.16), P = 0.10]均无统计学差异。随机对照研究的meta分析结果显示, 抗凝治疗可以有效降低肺癌患者的VTE发生率, 患者治疗出血并发症发生率的差异无统计学意义, 安全性较好。

关键词: 肺癌, 静脉血栓栓塞, 抗凝治疗, 出血, 系统评价

Abstract:

Venous thromboembolism (VTE) is a significant complication and a risk factor for mortality in patients with lung tumors. Anticoagulation therapy plays a crucial role in the prevention of VTE. However, its safety and effectiveness, specifically in lung cancer patients, have not been systematically evaluated. This study aimed to conduct a meta-analysis to assess the efficacy and safety of prophylactic anticoagulation in patients with lung cancer. We systematically searched for relevant literature published in Pubmed, Embase, CNKI, and Wanfang databases until September 2020 and screened the literature according to predefined inclusion and exclusion criteria. The included studies were evaluated for quality using the modified Jadad scale, and Review Manager 5.4 software was used for data analysis. Four randomized controlled trials (n = 2272 participants) were included in the meta-analysis. The quality evaluation revealed that two articles were of high quality (≥ 4 points), while the remaining articles were of low quality (≤ 3 points). The average Jadad score for all references was 3.5. The meta-analyses demonstrated that anticoagulant therapy significantly reduced the incidence of VTE in lung cancer patients [RR = 0.55, 95% CI (0.43, 0.70), P < 0.00001]. However, there were no statistically significant differences in the incidence of total bleeding [RR = 1.74, 95% CI (0.87, 3.50), P = 0.12], minor bleeding [RR = 1.64, 95% CI (0.66, 4.05), P = 0.29], and major bleeding [RR = 1.70, 95% CI (0.91, 3.16), P = 0.10]. In conclusion, anticoagulant therapy effectively reduced the incidence of VTE in lung cancer patients without a statistically significant increase in bleeding complications.

Key words: Lung neoplasms, Venous thromboembolism, Anticoagulant therapy, Hemorrhage, Meta-analysis

Supporting:

苏俐玫, 毛溪悦, 阳丽梅. 肺癌患者静脉血栓栓塞预防的疗效与安全性的meta分析[J]. 中国药学(英文版), 2023, 32(10): 852-860.

Limei Su, Xiyue Mao, Limei Yang. Efficacy and safety of venous thromboembolism prevention in lung cancer: a meta-analysis of randomized controlled studies[J]. Journal of Chinese Pharmaceutical Sciences, 2023, 32(10): 852-860.

图/表 9

Figure 1. Flowchart of literature search results.

Table 1. Characteristics of included studies.

Table 2. Jadad scores for the included studies.

Figure 2. Risk bias plot.

Figure 3. Forest plot of the incidence of anticoagulation prophylaxis against VTE in lung cancer patients.

Figure 4. Forest plot of the incidence of bleeding complications in anticoagulation treatment in lung cancer patients.

Figure 5. Forest plot of the incidence of minor bleeding complications in lung cancer patients.

Figure 6. Forest plot of the incidence of major bleeding complications in lung cancer patients.

Figure 7. Inverted funnel plot of the included study.

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肺癌患者静脉血栓栓塞预防的疗效与安全性的meta分析

Efficacy and safety of venous thromboembolism prevention in lung cancer: a meta-analysis of randomized controlled studies

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