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利伐沙班治疗CAVTE患者抗血栓有效性与安全性的Meta分析
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Abstract:
目的：系统评价利伐沙班治疗CAVTE的有效性和安全性。方法：采用计算机检索CNKI、Wanfang、维普、PubMed、The Cochrane Library、Web of Science、Embase数据库，收集利伐沙班(试验组)对比安慰剂或常规治疗CAVTE相关的随机对照试验，检索时限为各数据库自建库起至2024年6月，利用Cochrane协作网提供的偏倚风险评估表对纳入研究进行质量评价并提取数据，采用RevMan 5.3软件进行风险评估并进行Meta分析。结果：9项随机对照试验被纳入分析，包括1526例患者(试验组760例，对照组766例)。试验组药物为利伐沙班，对照组方案为安慰剂、VK拮抗剂、肝素制剂。结果显示，与对照组相比，口服利伐沙班能有效降低肿瘤患者的深静脉血栓复发率，差异有统计学意义[RR = 0.37, 95% CI: 0.17~0.79, P = 0.01]，在大出血率、全因死亡率、临床相关非大出血率、静脉血栓复发率、临床相关大出血率、肺栓塞率方面，差异均无统计学意义。结论：利伐沙班能有效降低肿瘤患者静脉血栓栓塞复发风险，安全性较好。
Objective: To systematically evaluate the effectiveness and safety of rivaroxaban in the treatment of CAVTE. Methods: CNKI, Wanfang, VIP, PubMed, The Cochrane Library, Web of Science, and Embase databases were searched to collect randomized controlled trials of rivaroxaban (test group) versus placebo or conventional treatment for CAVTE, and the time limit for searching was from the establishment of the databases to June 2024. A quality assessment of the included studies was performed, and data were extracted using the risk of bias assessment form provided by the Cochrane Collaboration. Risk assessment and meta-analysis were performed using RevMan 5.3 software. Results: Nine randomized controlled trials were included in the analysis. Included were 1526 patients (760 in the test group and 766 in the control group). The drug in the test group was rivaroxaban, and the control regimen was placebo, parenteral anticoagulant bridging vitamin K antagonist, and parenteral anticoagulant. The results showed that compared with the control group, oral rivaroxaban effectively reduced the recurrence rate of deep vein thrombosis in oncology patients, and the difference was statistically significant [RR = 0.37, 95% CI: 0.17~0.79, P = 0.01], and in terms of the rate of major hemorrhage, all-cause mortality rate, rate of clinically relevant non-major hemorrhage, rate of VTE recurrence, rate of clinically relevant major hemorrhage, and rate of pulmonary embolism, none of the differences were statistically significance. Conclusion: Rivaroxaban can effectively reduce the risk of recurrence of CAVTE venous thrombosis with a good safety profile.
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