rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2016-12-1-31-39rpcardio-1193Research ArticleORIGINAL STUDIESОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯEfficacy and safety of the new oral anticoagulants in the treatment of venous thromboembolic complications: meta-analysisЭФФЕКТИВНОСТЬ И БЕЗОПАСНОСТЬ НОВЫХ ПЕРОРАЛЬНЫХ АНТИКОАГУЛЯНТОВ У БОЛЬНЫХ С ВЕНОЗНЫМИ ТРОМБОЭМБОЛИЧЕСКИМИ ОСЛОЖНЕНИЯМИ: МЕТА-АНАЛИЗПетровВ. И.PetrovV. I.

д.м.н., профессор, академик РАН, зав. кафедрой клинической фармакологии и интенсивной терапии с курсами клинической фармакологии и клинической аллергологии факультета усовершенствования врачей ВолгГМУ

ШаталоваО. В.ShatalovaO. V.

к.м.н., ассистент той же кафедры

shov_med@mail.ruГорбатенкоВ. С.GorbatenkoV. S.

аспирант той же кафедры

СмусеваО. Н.SmusevaO. N.

д.м.н., доцент той же кафедры

МаслаковА. С.MaslakovA. S.

аспирант той же кафедры

Волгоградский государственный медицинский университет 400131, Волгоград, площадь Павших Борцов, 1РоссияVolgograd State Medical University. Pavshikh Bortsov pl. 1, Volgograd, 400131 RussiaRussian Federation2016090320161213139Copyright © Petrov V.I., Shatalova O.V., Gorbatenko V.S., Smuseva O.N., Maslakov A.S., 20162016Петров В.И., Шаталова О.В., Горбатенко В.С., Смусева О.Н., Маслаков А.С.Petrov V.I., Shatalova O.V., Gorbatenko V.S., Smuseva O.N., Maslakov A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/1193Aim

Aim. Analysis of the efficacy and safety of the new oral anticoagulants (NOACs) in the management of venous thromboembolism (VTE).

Material and methods

Material and methods. This meta-analysis of randomized controlled trials (RCTs) was made in accordance with the instructions “Preferred reporting items for systematic reviews and meta-analyses (PRISMA)”.

Results

Results. The meta-analysis included 5 RCTs. NOACs were as effective as vitamin K antagonists (VKAs) in preventing recurrent symptomatic VTE (RR=0.93; 95% CI 0.77-1.12; p=0.44). The incidence of recurrent thrombosis (RR=0.82; 95% CI 0.63-1.08; p=0.16) and deep vein thrombosis ± fatal or nonfatal pulmonary embolism (RR=1.06; 95% CI 0.81-1.40; p=0.66) was comparable in the groups of comparison. Meta-analysis of the safety of the NOACs suggested significant reduction of risk of major bleeding as compared with standard therapy (RR=0.54; 95% CI 0.42-0.69; р<0.00001). The incidence of all types of bleeding was significantly lower with NOACs (RR=0.70; 95% CI 0.51-0.95; p=0.02). All-cause mortality rate was comparable between the groups (RR=0.93; 95% CI 0.76-1.13; p=0.46).

Conclusions

Conclusions. NOACs are as effective as the standard therapy, at that they are much safer in VTE treatment.

Цель

Цель. Анализ эффективности и безопасности новых пероральных антикоагулянтов (НОАК) в сравнении со стандартной терапией венозных тромбоэмболических осложнений (ВТЭО).

Материал и методы

Материал и методы. Выполнен мета-анализ рандомизированных контролируемых исследований (РКИ) в соответствии с положениями инструкции «Предпочтительные параметры отчетности для систематических обзоров и мета-анализа (PRISMA)».

Результаты

Результаты. Для выполнения мета-анализа включено 5 РКИ. Эффективность НОАК по сравнению с традиционной терапией ВТЭО сопоставима: (отношение рисков [ОР]=0,93; 95% доверительный интервал [95% ДИ] 0,77-1,12; р=0,44). Частота развития повторного тромбоза (ОР=0,82; 95% ДИ 0,63-1,08; р=0,16) и тромбоза глубоких вен ± фатальная или нефатальная тромбоэмболия легочной артерии (ОР=1,06; 95% ДИ 0,81-1,40; р=0,66) также сопоставима в группах сравнения. Мета-анализ безопасности НОАК свидетельствует о значимом снижении риска развития массивного кровотечения в сравнении со стандартной терапией (ОР=0,54; 95% ДИ 0,42-0,69; р=р<0,00001). Частота развития всех кровотечений на фоне приема НОАК значимо меньше (ОР=0,70; 95% ДИ 0,51-0,95; р=0,02). Летальность от всех причин сопоставима (ОР=0,93; 95% ДИ 0,76-1,13; р=0,46).

Заключение

Заключение. НОАК по сравнению со стандартной терапией не уступают по эффективности, при этом являются более безопасными лекарственными препаратами в лечении ВТЭО.

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The authors declare that there are no conflicts of interest present.