Objective To conduct a systematic review of efficacy and safety of dabigatran 220 mg vs. enoxaparin for prevention of thromboembolism after hip or knee replacement. Methods CNKI, VIP, and Wanfang data Cochrane Library, Embase, Pubmed and Medline Databases, were searched from the 1990 to 2012. The references of these studies were also searched. Two independent researchers evaluated the included studies by using GRADE, the Meta-analysis was performed by Review Manager 5. 1 software. Results A total of 4 trials were reached the criteria, which included 10 265 patients. The efficacy of dabigatran 220 mg vs. enoxaparin has no significant difference for prevention of thromboembolism and the bleeding risk after hip or knee replacement, the results reveals that total VTE and all-cause mortality [ OR = 1. 01, 95% CI ( 0. 81 ~ 1.26)], proximal DVT [OR =0.76, 95% CI ( 0.55 ~ 1.07 )], major VTE and VTE related mortality [ OR =0.79,95% CI ( 0. 59 ~ 1. 06 ) ], major bleeding [ OR = 1. 11, 95% CI ( 0.75 ~ 1. 65 ) ], clinically relevant bleeding [ OR = 1. 18 , 95% CI ( 0. 92 ~ 1. 51 ) ]. Conclusion The efficacy of dabigatran 220 mg vs. enoxaparin has no significant difference for prevention of thromboembolism and the bleeding risk after hip or knee replacement.%目的 系统评价达比加群220 mg相比于依诺肝素对膝、髋关节置换术后静脉血栓预防的疗效及安全性.方法 计算机检索中国知网(CNKI)、维普数据库(VlP)、万方数据库(Wanfang Data)、Cochrane Library、Embase、Pubmed and Medline Databases,同时追溯纳入文献的参考文献,时间为1990-2012年.2位研究员根据GRADE 系统推荐分级方法,对纳入研究的文献质量进行严格评价和资料提取,对符合质量标准的 RCT采用Rview Manager 5.1进行 Meta 分析.结果共纳入4篇文献,包括10 265例患者.结果显示达比加群220 mg相比于依诺肝素不增加膝、髋关节置换术后静脉血栓形成和出血的风险,其结果分别为总静脉血栓和全因病死率[OR=1.01,95%CI(0.81~1.26)]、近端静脉血栓[OR=0.76,95%CI(0.55~1.07)]、主要静脉血栓和静脉血栓相关死亡[OR=0.79,95%CI(0.59~1.06)]、主要出血[OR=1.11,95%CI(0.75~1.65)]、临床相关出血[OR=1.18,95%CI(0.92~1.51)].结论 达比加群220 mg预防膝、髋关节置换术后静脉血栓的疗效及安全性不亚于依诺肝素,且其出血风险不存在明显的差别.
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