【メタ解析】DOACの減量投与はVTE再発予防に有効ですか？

【背景】

現状DOACの再発予防は3種類が使用可能だが、VTEの再発予防について減量基準があるのはエドキサバンのみである。

しかし実際には他のDOACも使用されていることがある。

参考文献：Reduced‐dose direct oral anticoagulants in the extended treatment of venous thromboembolism: a systematic review and meta‐analysis

https://www.ncbi.nlm.nih.gov/pubmed/?term=29772108

PMID: 29772108

-----------------------------------------------------------------------------------------

研究デザイン：メタ解析

論文の内容

P：3-12か月の抗凝固療法を終えた18歳以上のVTE患者

I：通常量DOAC・減量DOAC

C：抗血小板剤orプラセボ

O：VTE関連死亡を含むVTEの再発、出血イベント

・Primary Outcomeは明確になっているか　　　　　→　　明確である

・真のアウトカムかどうか　　　　　　　　　　　 →　　真のアウトカムといえる

【メタ解析における4つのバイアス】

1、評価者バイアス

・Screening of titles and abstracts for eligibility was done independently by two reviewers (LV and KB) in duplicate. The full texts of articles found to be potentially eligible were screened by the two independent reviewers. Conflicts were addressed by consensus involving consultation of the other authors. If data from a single trial was presented in multiple publications, secondary publications were also utilized for data extraction.

・data was extracted independently by two authors in duplicate (LV and KB). Final entered data was compared and discrepancies were addressed with article review and consensus. In the case of missing or unavailable data, an attempt would be made to contact the authors of the studies.

→2人の査読者（LVおよびKB）によって独立して行われた。

2、出版バイアス

・we searched for titles in the MEDLINE, EMBASE, and CINAHL databases up to April 2017. Relevant conference abstracts from the International Society of Thrombosis and Hemostasis and American Society of Hematology were hand-searched. A review of reference lists from retrieved titles was conducted. There were no language-based restrictions

→MEDLINE,EMBASE,CINAHLdatabasesから抽出。言語制限なし。著者たちに連絡をとった。Funnel plotは確認できず。

3、元論文バイアス

・The literature search was completed in March 2017 and retrieved 1399 unique citations. The full text of 17 articles and abstracts were reviewed, and ultimately 2 met criteria for inclusion involving 5851 patients

→2RCTのメタ解析。元論文もITT解析されてる。

f:id:pharmapon:20180817152530p:plain