| Objective: The first study:To evaluate the efficacy and safety of low-molecular weight heparins(LMWH)and unfractionated heparin(UFH)in the treatment of pulmonary thromboembolism(PTE),by meta analysis.The second study:To investigate the effectiveness and security about the treatment of rivaroxaban and warfarin for pulmonary thromboembolism.Methods: The first study: We searched four English databases(EMbase,PubMed,The Cochrane Library and Web of science)by computer,Data from inception to January 2019,the same time we searched three Chinese databases(China Biomedical Literature Database(CBM),China Knowledge Network(CKNI)and WanFang Data),Data from inception to January 2019.To collect the randomized controlled trial(RCT)about LMWH and UFH for PTE.The key words used include:Chinese search terms: pulmonary embolism and its synonyms(pneumonia pseudotumor,pulmonary disease syndrome,lung disease,lung performance,lung disease,pulmonary isolation,pulmonary infarction),low molecular weight heparin and unfractionated heparin;English search terms include: random,Pulmonary Embolism and its synonyms(Pulmonary Embolisms,Embolism,Pulmonary,Pulmonary Thromboembolisms,Thromboembolism,Pulmonary),Low-molecular-weight heparins and its synonyms(Heparin,Low Molecular Weigh,LMWH,Low Molecular Weight Heparin),Unfractionated heparin and its synonyms(Heparin,Unfractionated,Heparinic Acid,Liquaemin,Sodium Heparin,Heparin Sodium).The second study:We searched main databases by computer,Data from inception to January 2019,to collect the randomized controlled trial(RCT)about rivaroxaban and warfarin in the treatment of PTE.The search terms used include:Chinese search terms: pulmonary embolism and its synonyms(pneumonia pseudotumor,pulmonary disease syndrome,lung disease,lung performance,lung disease,pulmonary isolation,pulmonary infarction,etc.warfarin and rivaroxaban;English search terms include: random,Pulmonary Embolism and its synonyms(Pulmonary Embolisms,Embolism,Pulmonary,Thromboembolism,Pulmonary),rivaroxaban and its synonyms(Xarelto)warfarin and its synonyms(Aldocumar,Gen-Warfarin,Warfan)etc.Two researchers independently completed the literature database search,data statistics and other processes,if the data are not uniform and the results are inconsistent,the third person can intervene.Using RevMan5.3 software to conduct Meta-analysis.Results: The first study included 38 RCT,a total of 3458 patients with PTE.Meta analysis results are as follows:(1)validity analysis:(1)Effectiveness included in25 studies and the results showed that:[RR=1.14,95%CI(1.09,1.19),P < 0.05].(2)The recurrence rate of venous thromboembolism:6 studies were included and the results showed that:[RR=0.40,95%CI(0.17,0.93),P=0.03].(3)The change of clotting time:2studies were included and the results showed that: [MD=-1.34,95%CI(-1.99,-0.69),P< 0.05].(4)Platelet adhesion rate were included in 3 studies.The results showed that:[MD=-5.53,95%CI(-10.13,-0.93),P = 0.02](5)The change of fibrinogen:5 studies were included and the results showed that :[MD=-0.48,95%CI(-0.70,-0.27),P <0.05].From the above results,LMWH is superior to UFH in the treatment of PTE.(2)Safety analysis:(1)bleeding included in 30 studies,the results showed that[RR= 0.43,95% CI(0.33,0.56),P <0.05](2)thrombocytopenia were included in 10 studies,the results showed that[RR = 0.63,95% CI(0.29,1.35),P = 0.23].From the above results,it is concluded that LMWH is safer than UFH in the treatment of PTE.(3)Length of stay and cost of hospitalization analysis:(1)length of hospital stay were included in 7 studies,the results showed that: [MD =-4.43,95% CI(-4.78,-4.09),P <0.05](2)Hospitalization expenses were included in 6 studies,the results showed that:[MD=-3.17,95% CI(-3.53,-2.81),P<0.05].From the above analysis results:LMWH compared with UFH can shorten the length of hospital stay,reduce the cost of treatment.(4)others:(1)the change of oxygenation index,3 studies were included and the results showed that:[MD=-4.84,95% CI(-22.26,12.58),P=0.59](2)the change of Lung blockage rate,2 studies were included and the results showed that:[MD=-4.04,95% CI(-11.40,3.31),P=0.28](3)the change of Ventilation/perfusion ratio,2 studies were included and the results showed that: [ MD=0.08,95%CI(-0.27,0.43),P=0.65](4)the change of prothrombin time,4 studies were included and the results showed that:[MD=-0.26,95% CI(-0.76,1.28),P=0.62](5)death,13 studies were included and the results showed that:[RR=0.66,95% CI(0.43,1.10),P=0.06](6)the change of D-dimer,3 studies were included and the results showed that:[MD=-0.05,95% CI(-0.79,0.68),P=0.89].From the above results,it is concluded that there was no difference in some indexes between LMWH and UFH in the treatment of PTE.The second study included 17 RCT.(1)Efficiency analysis:[OR=1.81,95%CI(1.30,2.54),P=0.0005](2)The changes of heart rate: [MD = 3.78,95% CI(0.23,7.33),P = 0.04].(3)The changes of D-dimer rate: [MD =-0.22,95% CI(-0.35,-0.10),P = 0.0006].(4)The changes of respiratory frequency rate: [MD=-2.95,95% CI(-4.65,-1.25),P=0.0007].(5)The changes of Endothelin-1(ET-1)rate: [MD=0.57,95% CI(-0.35,1.48),P = 0.22].(6)The changes of Plasma protein C(PC)rate: [MD =-0.12,95% CI(-0.38,0.14),P = 0.37].(7)The changes of Plasma protein S(PS)rate: [MD= 0.44,95% CI(0.02,0.85),P = 0.04].(8)The changes of nitric oxide(NO)rate: [MD=-2.63,95% CI(-5.57,0.30),P = 0.08].(9)The changes of tissue plasminogen activator(t-PA)rate: [MD=0.03,95% CI(-0.22,0.29),P=0.80].(10)The changes of thromboxane B2(TXB2)rate: [MD = 0.13,95% CI(-8.90,9.16),P = 0.98].(11)Mortality: [OR=1.12,95% CI(0.77,1.64),P=0.54].(12)Bleeding:[OR=0.20,95%CI(0.13,0.31),P<0.00001].Conclusion: The first study:Compared with UFH,LMWH is more effective in the treatment of PTE.It can not only reduce the recurrence rate of VTE,but also improve some indexes of coagulation system in patients.At the same time,LMWH can reduce the cost of treatment and shorten the patient's hospitalization period.Meanwhile LMWH can reduce the occurrence of bleeding in terms of safety.The second study:It was found that rivaroxaban is not only more effective in the treatment of PTE than warfarin,but also decreased the levels of heart rate,respiratory rate and D-dimer in PTE patients,thus improving the overall level.In addition,rivaroxaban can reduce the occurrence of bleeding events,and is better than warfarin in terms of safety.However,there were no significant differences in mortality and vascular endothelial function(ET-1,PC,NO,t-PA,TXB2). |
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