Efficacy and safety of anticoagulant for treatment and prophylaxis of VTE patients with renal insufficiency: a systemic review and meta-analysis

被引：0

作者：

Shuangshuang Ma

Guohui Fan

Feiya Xu

Xiaomeng Zhang

Yinong Chen

Yuzhi Tao

Yishan Li

Yanshuang Lyu

Peiran Yang

Dingyi Wang

Zhenguo Zhai

Chen Wang

机构：

[1] Beijing University of Chinese Medicine. National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine,School of Populat

[2] Chinese Academy of Medical Sciences,National Center for Respiratory Medicine; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine

[3] Department of Pulmonary and Critical Care Medicine,Department of Physiology, Institute of Basic Medical Sciences, State Key Laboratory of Respiratory Health and Multimorbidity

[4] Center of Respiratory Medicine,Department of Respiratory Medicine

[5] China-Japan Friendship Hospital,undefined

[6] Chinese Academy of Medical Sciences & Peking Union Medical College; State Key Laboratory of Respiratory Health and Multimorbidity; Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College),undefined

[7] Ministry of Education,undefined

[8] Chinese Academy of Medical Sciences; Department of Clinical Research and Data Management,undefined

[9] Center of Respiratory Medicine,undefined

[10] China-Japan Friendship Hospital,undefined

[11] Graduate School of Capital Medical University,undefined

[12] Peking University China‑Japan Friendship School of Clinical Medicine,undefined

[13] The First Bethune Hospital of Jilin University,undefined

[14] The First Clinical Medical College,undefined

[15] Shanxi Medical University,undefined

[16] Changping Laboratory,undefined

[17] Chinese Academy of Medical Sciences,undefined

[18] Peking Union Medical College,undefined

[19] Chinese Academy of Medical Sciences and School of Basic Medicine,undefined

[20] Peking Union Medical College; National Center for Respiratory Medicine; Institute of Respiratory Medicine,undefined

[21] Chinese Academy of Medical Sciences,undefined

[22] National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine,undefined

[23] Chinese Academy of Medical Sciences,undefined

[24] Department of Pulmonary and Critical Care Medicine,undefined

[25] Center of Respiratory Medicine,undefined

[26] China-Japan Friendship Hospital,undefined

[27] National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases,undefined

[28] Chinese Academy of Medical Sciences,undefined

[29] Peking Union Medical College,undefined

[30] Capital Medical University,undefined

来源：

Thrombosis Journal | / 22卷

关键词：

Venous thromboembolism; Renal insufficiency; Efficacy; Safety; Meta-analysis;

D O I：

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中图分类号：

学科分类号：

摘要：

Patients with venous thromboembolism (VTE) comorbid renal insufficiency (RI) are at higher risk of bleeding and thrombosis. Recommendations in guidelines on anticoagulation therapy for those patients remain ambiguous. The goal of this study is to compare the efficacy and safety between different anticoagulant regimens in VTE patients comorbid RI at different stages of treatment and prophylaxis. We performed English-language searches of Pubmed, EMBASE, and Web of Science (inception to Nov 2022). RCTs evaluated anticoagulants for VTE treatment at the acute phase, extension phase, and prophylaxis in patients with RI and reported efficacy and safety outcomes were selected. The methodological quality of the studies was assessed at the outcome level using the risk-of-bias assessment tool developed by the Cochrane Bias Methods Group. A meta-analysis of twenty-five RCTs was conducted, comprising data from twenty-three articles, encompassing a total of 9,680 participants with RI. In the acute phase, the risk of bleeding was increased with novel oral anticoagulants (NOACs) compared to LMWH (RR 1.29, 95% CI 1.04–1.60). For the prophylaxis of VTE, NOACs were associated with an elevated risk of bleeding compared with placebo (RR 1.31, 95%CI 1.02–1.68). In comparison to non-RI patients, both NOACs and vitamin K antagonists (VKA) could increase the risk of bleeding among RI patients (RR 1.45, 95%CI 1.14–1.84 and RR 1.53, 95%CI 1.25–1.88, respectively) during acute phase, while NOACs may increase the incidence of VTE in RI population (RR 1.74, 95%CI 1.29–2.34). RI patients who are under routine anticoagulation have a significantly higher risk of adverse outcomes. LMWH is the most effective and safe option for VTE treatment or prophylaxis in patients with RI.

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