利伐沙班与华法林治疗中国人群血栓性疾病的疗效及安全性对比的Meta分析

    Safety and Efficacy of Rivaroxaban Compared to Warfarin for The Treatment of Thrombosis in Chinese: A Meta-Analysis

    • 摘要: 目的 系统评价对比利伐沙班和华法林治疗中国人群血栓性疾病中的疗效及安全性。 方法 计算机检索Cochrane图书馆、PubMed、EMBASE、Web of Science、CBM、VIP、CNKI、Wanfang 数据库中关于利伐沙班和华法林治疗血栓性疾病疗效比较的文献,检索时间截止至2017年1月。由2 名评价者独立选择文献、提取资料和评估方法学质量后,采用RevMan 5.3 软件进行Meta 分析。 结果 纳入13 个研究,合计1 004例临床确诊为血栓性疾病的患者。Meta分析结果显示: 华法林组治疗后血栓复发率高于利伐沙班组(比值比0.45,95%可信区间0.30~0.67,P<0.000 1),利伐沙班组血栓消失时间短于华法林组(均数差-11.16,95%可信区间-13.24~-9.07,P<0.000 01),差异均有统计学意义。华法林组治疗后总出血率高于利伐沙班组(比值比0.34,95%可信区间0.20~0.58,P<0.000 1),但华法林组和利伐沙班组新发血栓率的差异无统计学意义(比值比0.69,95%可信区间0.25~1.95, P=0.49)。 结论 与华法林相比,利伐沙班可以降低患者血栓复发率和减少血栓消失时间,疗效更为显著,且可减少出血事件的发生,在血栓性疾病的治疗中是一种较为理想的抗凝剂。

       

      Abstract: Objective To systematically evaluate the safety and efficacy of Rivaroxaban compared to Warfarin for the treatment of thrombosis in Chinese. Methods The databases including The Cochrane Library,PubMed,EMBASE,Web of Science,CBM,VIP,CNKI,Wanfang Data were searched from the inception to January 2017 to collect the randomized controlled trials (RCTs) related to the safety and efficacy of Rivaroxaban compared to Warfarin for the treatment of thrombosis. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of thirteen studies were included, involving 1 004 patients. Meta-analyses results showed, Rivaroxaban significantly lowered the risk of recurrent thrombosis and reduced the time of thrombolysis compared to Warfarin(OR=0.45,95%CI 0.30~0.67; MD=-11.16,95%CI -13.24~-9.07), and Warfarin groups had higher bleeding occurrence rate and new thrombosis occurrence rate when compared with Rivaroxaban group(OR=0.34,95%CI 0.20~0.58;OR=0.69,95%CI 0.25~1.95), but the new thrombosis occurrence rate had no statistical difference between the two groups. Conclusion Rivaoxaban group was superior to Warfarin group in the efficacy and safety for the treatment of thrombosis as Rivaroxaban significantly lowered the risk of recurrent thrombosis and reduced the time of thrombolysis and had a lower bleeding occurrence rate,but further clinical research is required before Rivaroxaban can be considered standard treatment of thrombosis.

       

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