内镜黏膜下剥离术围手术期抗栓治疗安全性评价的Meta分析
发布时间：2019-06-11 05:56
【摘要】：目的:探讨内镜黏膜下剥离术(ESD)围手术期不同抗栓治疗方案的安全性,分别对停用抗栓药和持续使用抗栓药两方面进行系统评价,以期日后为指导我国内镜黏膜下剥离术围手术期抗栓策略的制定提供理论依据。方法:应用计算机系统检索Web of Science、PubMed、EMbase、Cochrane Central Trails等外文数据库,以及其它国内常用的数据库,并辅以手动检索、文献追溯等方法,收集有关接受ESD的患者在围手术期间抗栓治疗的临床试验,检索时间截止至2017年1月,检索语言为英文和中文。由2名研究员按照预先制定的纳入与排除标准,独立对所检索出的文献完成文献筛选、质量评价和数据提取等步骤后,再采用RevMan 5.3软件进行Meta分析,并对各研究进行数据合并、异质性检验以及评估发表偏倚。若2名研究员在上述过程中的任一环节存在分歧都需先进行讨论,必要时由第三人介入做出最终决定。结果:本文共纳入16项符合要求的回顾性病例对照研究,共包括10535例受试者,其中服用抗栓药物治疗的患者有1762例,从未服用过抗栓药物的患者有8773例。经Meta分析结果显示:(1)与从未服用过抗栓药物的患者相比,服用抗栓药物者即使在ESD术前停用抗栓药仍会增加术后出血的风险(OR=1.66,95%CI:1.15~2.39,P=0.007),特别是迟发性出血的风险(OR=2.66,95%CI:1.42~4.98,P=0.002),而对早期出血无明显影响(OR=1.38,95%CI:0.74~2.54,P=0.31);亚组分析结果显示,术后7天内恢复使用抗栓药物会明显增加ESD术后的出血风险(OR=2.46,95%CI:1.54~3.93,P=0.0002),而术后超过7天恢复抗栓药则相对安全(OR=1.06,95%CI:0.71~1.57,P=0.78);此外,联用多种抗栓药者的术后出血风险会明显增加(OR=5.17,95%CI:3.13~8.54,P0.00001),而单用抗血小板药者则相对安全(OR=2.08,95%CI:0.93~4.63,P=0.07)。(2)在ESD围手术期持续使用抗栓药物会显著增加术后的出血风险,无论是与从未服用抗栓药物者相比(OR=5.97,95%CI:4.36~8.18,P0.00001),还是与术前停用抗栓药物者相比(OR=3.44,95%CI:1.82~6.50,P=0.0001);亚组分析结果显示,使用肝素过渡治疗者的术后出血风险明显增加(OR=4.20,95%CI:1.94~9.09,P=0.0003),但发生血栓栓塞事件的风险并未下降(OR=4.67,95%CI:1.20~18.17,P=0.03);持续服用低剂量阿司匹林,与术前停用抗栓药物者相比不会增加ESD术后的出血风险(OR=1.22,95%CI:0.17~8.61,P=0.84)。结论:服用抗栓药物是ESD术后出血的危险因素,术前停用抗栓药而在术后7天内恢复使用、和同时服用多种抗栓药物都会显著增加ESD术后的出血风险,尤其是迟发性出血的风险,而对早期出血无明显影响;在ESD围手术期使用肝素过渡治疗会显著增加其术后的出血风险,且并不会降低发生血栓栓塞事件的发生;此外,在围手术期继续服用低剂量阿司匹林并不是ESD术后出血的危险因素。但是,将来仍需要更多的大样本、多中心、高质量的临床试验来进一步证实。
[Abstract]:Objective: to investigate the safety of different antisuppressive regimens during the perioperative period of endoscopic submucous exudation of (ESD), and to evaluate the discontinuation of antisuppressive drugs and the continuous use of antisuppressive drugs, respectively. In order to provide theoretical basis for guiding the formulation of perioperative antithrombus strategy during endoscopic submucous peeling in China in the future. Methods: Web of Science,PubMed,EMbase,Cochrane Central Trails and other foreign language databases, as well as other databases commonly used in China, were searched by computer system, supplemented by manual retrieval and literature traceability. Clinical trials of patients receiving ESD during perioperative antithrombus therapy were collected and searched in English and Chinese until January 2017. According to the pre-established inclusion and exclusion criteria, two researchers independently completed the steps of literature screening, quality evaluation and data extraction, and then used RevMan 5.3 software for Meta analysis. Data consolidation, heterogeneity test and evaluation bias were carried out. If there are differences between the two researchers in either part of the process, they need to be discussed first, and if necessary, a third person will intervene to make the final decision. Results: a total of 16 retrospective case-control studies were included, including 10535 subjects, including 1762 patients treated with antisuppressive drugs and 8773 patients who had never taken antisuppressive drugs. The results of Meta analysis showed that: (1) compared with patients who had never taken antisuppressive drugs, patients who took antisuppressive drugs increased the risk of postoperative bleeding even if they stopped using antisuppressive drugs before ESD (OR=1.66,95%CI:1.15~2.39,P=0.007). In particular, the risk of delayed bleeding (OR=2.66,95%CI:1.42~4.98,P=0.002) had no significant effect on early bleeding (OR=1.38,95%CI:0.74~2.54,P=0.31). The results of subgroup analysis showed that the resumption of antisuppressive drugs within 7 days after operation significantly increased the risk of bleeding (OR=2.46,95%CI:1.54~3.93,P=0.0002) after ESD. However, it was relatively safe to recover antisuppressive drugs more than 7 days after operation (OR=1.06,95%CI:0.71~1.57,P=0.78). In addition, the risk of postoperative bleeding was significantly increased in patients with multiple antithrombotic drugs (OR=5.17,95%CI:3.13~8.54,P0.00001), while those treated with antiplatelet drugs alone were relatively safe (OR=2.08,95%CI:0.93~4.63,). P 鈮，
本文编号：2497062
[Abstract]:Objective: to investigate the safety of different antisuppressive regimens during the perioperative period of endoscopic submucous exudation of (ESD), and to evaluate the discontinuation of antisuppressive drugs and the continuous use of antisuppressive drugs, respectively. In order to provide theoretical basis for guiding the formulation of perioperative antithrombus strategy during endoscopic submucous peeling in China in the future. Methods: Web of Science,PubMed,EMbase,Cochrane Central Trails and other foreign language databases, as well as other databases commonly used in China, were searched by computer system, supplemented by manual retrieval and literature traceability. Clinical trials of patients receiving ESD during perioperative antithrombus therapy were collected and searched in English and Chinese until January 2017. According to the pre-established inclusion and exclusion criteria, two researchers independently completed the steps of literature screening, quality evaluation and data extraction, and then used RevMan 5.3 software for Meta analysis. Data consolidation, heterogeneity test and evaluation bias were carried out. If there are differences between the two researchers in either part of the process, they need to be discussed first, and if necessary, a third person will intervene to make the final decision. Results: a total of 16 retrospective case-control studies were included, including 10535 subjects, including 1762 patients treated with antisuppressive drugs and 8773 patients who had never taken antisuppressive drugs. The results of Meta analysis showed that: (1) compared with patients who had never taken antisuppressive drugs, patients who took antisuppressive drugs increased the risk of postoperative bleeding even if they stopped using antisuppressive drugs before ESD (OR=1.66,95%CI:1.15~2.39,P=0.007). In particular, the risk of delayed bleeding (OR=2.66,95%CI:1.42~4.98,P=0.002) had no significant effect on early bleeding (OR=1.38,95%CI:0.74~2.54,P=0.31). The results of subgroup analysis showed that the resumption of antisuppressive drugs within 7 days after operation significantly increased the risk of bleeding (OR=2.46,95%CI:1.54~3.93,P=0.0002) after ESD. However, it was relatively safe to recover antisuppressive drugs more than 7 days after operation (OR=1.06,95%CI:0.71~1.57,P=0.78). In addition, the risk of postoperative bleeding was significantly increased in patients with multiple antithrombotic drugs (OR=5.17,95%CI:3.13~8.54,P0.00001), while those treated with antiplatelet drugs alone were relatively safe (OR=2.08,95%CI:0.93~4.63,). P 鈮，
本文编号：2497062
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