不同原发肿瘤部位癌症患者抗凝预防动脉血栓栓塞的系统评价与Meta分析
Anticoagulation for the prevention of arterial thromboembolism in cancer patients by primary tumour site: a systematic review and meta-analysis of randomized trials
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影响因子:6.1
分区:医学2区 / 药学1区 心脏和心血管系统3区
发表日期:2025 Jan 11
作者:
Yan Xu, Caroline Mallity, Erin Collins, Deborah M Siegal, Tzu-Fei Wang, Marc Carrier
DOI:
10.1093/ehjcvp/pvae068
keywords:
Anticoagulants; Arterial thromboembolism; Bleeding; Cancer; Prevention
摘要
在门诊癌症患者中，动脉血栓栓塞（ATE）的发生率因原发肿瘤部位不同而异。然而，目前尚不清楚这是否改变了预防性抗凝治疗在ATE预防中的益 harm 比。本文系统评价了根据原发肿瘤部位，抗凝药物预防ATE的疗效和安全性。我们利用Medline、Embase、SCOPUS和CENTRAL数据库，筛选比较预防性抗凝与不抗凝的随机对照试验，纳入启动肿瘤靶向系统治疗的门诊癌症患者。采用随机效应模型，对症状性ATE（急性缺血性卒中、急性心肌梗死或周边动脉闭塞）和大出血的发生率及抗凝引起的风险差（RD）进行Meta分析。共纳入10项随机对照试验，涉及9875例患者，随访时间从3.3至68个月（中位数6.6个月）。整体来看，预防性抗凝未显著降低ATE风险（RD -0.49%；95% CI -0.49%至0.01%；I2=0%），但在胰腺癌患者中具有保护作用（RD -3.2%；95% CI -5.7%至-0.8%；I2=0%），且未增加大出血风险（RD -1.4%；95% CI -4.6%至1.8%；I2=0%）。在其他肿瘤部位中，未观察到抗凝对ATE风险的显著降低。依据现有证据，整体上预防性抗凝未能降低门诊癌症患者的ATE风险，但在胰腺癌患者中观察到较低的ATE发生率，未来应进一步研究抗凝预防胰腺癌患者的血栓风险。
Abstract
The incidence of arterial thromboembolism (ATE) among ambulatory cancer patients varies by primary tumour site. However, it is unclear whether this alters the benefit-to-harm profile of prophylactic anticoagulation for ATE prevention. Therefore, we systematically evaluated the efficacy and safety of anticoagulants for ATE prevention among ambulatory cancer patients according to the primary tumour site.We conducted a systematic review using Medline, Embase, SCOPUS, and CENTRAL, and included randomized trials comparing prophylactic anticoagulation to no anticoagulation among ambulatory cancer patients who initiated tumour-directed systemic therapy. The incidence of symptomatic ATE (acute ischaemic stroke, acute myocardial infarction, or peripheral artery occlusion) and major bleeding, as well as risk differences (RDs) attributable to anticoagulation, were meta-analysed by primary tumour site using random-effects modelling. We included 10 randomized controlled trials with 9875 patients with follow-up ranging from 3.3 to 68 (median 6.6) months. While prophylactic anticoagulation did not reduce ATE risks overall (RD -0.49%; 95% CI -0.49% to 0.01%; I2 = 0%), it conferred a protective effect among pancreatic cancer patients (RD -3.2%; 95%CI -5.7% to -0.8%; I2 = 0%) without a detectable increase in major bleeding (RD -1.4%; 95% CI -4.6% to 1.8%; I2 = 0%). Prophylactic anticoagulation was not associated with ATE risk reduction in other tumour sites.Based on available evidence, prophylactic anticoagulation did not reduce ATE risk among ambulatory cancer patients overall. However, we observed a lower incidence of ATE among pancreatic cancer patients randomized to receive anticoagulation. Prophylactic anticoagulant use to reduce ATEs in pancreatic cancer should be evaluated in future research.