摘要
目的 系统评价国内上市4种低分子肝素(依诺肝素、那屈肝素、达肝素和贝米肝素)预防骨科大手术静脉血栓栓塞症(VTE)的有效性、安全性及经济性。方法 检索PubMed、Embase、Cochrane Library、CNKI、VIP、Wanfang以及CMB等数据库,搜集相关的随机对照试验(RCTs)文献资料,按照纳入排除标准对文献资料进行筛选、提取和质量评价,采用Stata 15.0软件,以致死性肺栓塞(PE)发生率、非致死性PE发生率、主要出血发生率、VTE发生率、深静脉血栓(DVT)发生率以及全因死亡率为结局指标,进行网状Meta分析并评价低分子肝素的有效性和安全性。根据网状Meta分析的结果采用最小成本分析法(CMA)进行药物经济学评价。结果 共纳入26篇RCTs研究,包括6 939例患者。网状Meta分析结果显示:各低分子肝素在骨科大手术患者术后致死性PE发生率、非致死性PE发生率、主要出血发生率、VTE发生率、DVT发生率和全因死亡率的差异无统计学意义(P> 0.05)。最小成本分析结果显示:依诺肝素、那屈肝素、达肝素和贝米肝素按照药品说明书和指南推荐预防剂量和最短疗程(10 d)的平均药品成本分别为440.31、568.99、489.80、1 698.20元,依诺肝素的经济性最佳。结论 上市的4种低分子肝素的有效性和安全性基本相同,依诺肝素相比其他低分子肝素在预防骨科大手术后VTE更具经济学优势。
AIM To systematically evaluate the efficacy,safety and economy of 4 kinds of low-molecular-weight heparins(LMWHs)(enoxaparin,nadroparin,dalteparin,bemiparin)for prevention of venous thromboembolism(VTE)in major orthopedic surgery.METHODS PubMed,Embase,Cochrane Library,CNKI,VIP,Wanfang and CMB databases were searched to collect relevant randomized controlled trials(RCTs).RCTs were screened,extracted and assessed according to the inclusion and exclusion criteria.Network Meta-analysis was conducted by using Stata 15.0 software to evaluate the efficacy and safety of LMWHs in the incidence of fatal pulmonary embolism(PE),the incidence of non-fatal PE,the incidence of major bleeding,the incidence of VTE,the incidence of deep vein thrombosis(DVT)and all-cause mortality.Based on the results of network Meta-analysis,the cost minimization analysis(CMA)was used to evaluate the pharmacoeconomic.RESULTS A total of 26 RCTs including 6939 patients were included.The results of network Metaanalysis showed that there was no statistical difference in the incidence of fatal PE,non-fatal PE,major bleeding,VTE,DVT,and all-cause mortality among low molecular weight heparins in major orthopedic surgery patients.The results of CMA showed that considering the recommended preventive dose and the shortest course of treatment(10 d)due to drug labeling and guidelines,the average drug costs of enoxaparin,nadroparin,dalteparin,and bemiparin were 440.31 yuan,568.99 yuan,489.80 yuan,and 1698.20 yuan,respectively.Enoxaparin had the best economy.CONCLUSION There is no difference in efficacy and safety among the 4 kinds of LMWHs.Compared with other 3 kinds of LMWHs,enoxaparin shows superiority in economic for preventing VTE after major orthopedic surgery.
作者
朴慧玲
谷旭瑞
周凌云
周光亮
蒋安琪
谢悦良
左笑丛
PIAO Huiling;GU Xurui;ZHOU Lingyun;ZHOU Guangliang;JIANG Anqi;XIE Yueliang;ZUO Xiaocong(Department of Pharmacy,Third Xiangya Hospital,Central South University,Changsha 410013,China;Center for Comprehensive Evaluation of Drug Clinical of Hunan Provincial,Changsha 410013,China;Department of Clinical Pharmacy,Faculty of Pharmacy,Zunyi Medical University,Zunyi 563006,China)
出处
《中国临床药学杂志》
CAS
2022年第10期746-755,共10页
Chinese Journal of Clinical Pharmacy
基金
湖南省医学会科研基金-临床药学重点项目(编号HMA202001003)
湖南省药学会科研基金(编号2020YXH010)
第二轮湖南省高层次卫生人才“225”工程培养对象
中南大学教育教学改革研究项目(编号2022jy168-2)
关键词
低分子肝素
骨科大手术
静脉血栓栓塞症
网状Meta分析
经济学评价
flow-molecular-weight heparin
major orthopedic surgery
venous thromboembolism
network Metaanalysis
economic evaluation
作者简介
第一作者:朴慧玲,硕士研究生。研究方向:临床药学。E-mail:piaohuiling21@163.com;通信作者:谢悦良,副主任药师。研究方向:临床药学和药品临床综合评价。E-mail:xyl152@163.com;通信作者:左笑丛,主任药师。研究方向:临床药学与临床药理学。E-mail:zuoxc08@126.com
