asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2024-032asurgery-467Research ArticleФЛЕБОЛОГИЯPHLEBOLOGYЭффективность и безопасность прямых оральных антикоагулянтов при имплантированном кава-фильтре: систематический обзор литературы и метаанализEfficacy and safety of direct oral anticoagulants in patients with implanted inferior vena cava filters: a systematic review and meta-analysishttps://orcid.org/0000-0002-1306-1502СчастливцевИ. В.SchastlivtsevI. V.

Счастливцев Илья Вениаминович, к.м.н., доцент кафедры общей хирургии имени В.М. Буянова 

117997, Россия, Москва, ул. Островитянова, д. 1 

Ilya V. Schastlivtsev, Cand. Sci. (Med.), Associate Professor of the Department of General Surgery named after V.M. Buyanov

1, Ostrovityanov St., Moscow, 117997, Russia 

schastlivtsev.ilya@gmail.comhttps://orcid.org/0009-0005-3594-3433КозловаВ. В.KozlovaV. V.

Козлова Валерия Владимировна, студентка 

117997, Россия, Москва, ул. Островитянова, д. 1 

 Valeriya V. Kozlova, Student 

1, Ostrovityanov St., Moscow, 117997, Russia 

v.v.kozlova25@gmail.comhttps://orcid.org/0000-0003-3757-8861БарганджияА. Б.BargandzhiyaA. B.

Барганджия Астанда Беслановна, к.м.н., доцент кафедры общей хирургии имени В.М. Буянова 

117997, Россия, Москва, ул. Островитянова, д. 1 

Astanda B. Bargandzhiya, Cand. Sci. (Med.), Associate Professor of the Department of General Surgery named after V.M. Buyanov 

1, Ostrovityanov St., Moscow, 117997, Russia 

astandasofiya@gmail.comhttps://orcid.org/0000-0002-5358-7218ЛобастовК. В.LobastovK. V.

Лобастов Кирилл Викторович, д.м.н., доцент кафедры общей хирургии имени В.М. Буянова 

117997, Россия, Москва, ул. Островитянова, д. 1 

Kirill V. Lobastov, Dr. Sci. (Med.), Associate Professor of the Department of General Surgery named after V.M. Buyanov 

1, Ostrovityanov St., Moscow, 117997, Russia 

lobastov_kv@mail.ruРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation2024161120242123243Copyright © Счастливцев И.В., Козлова В.В., Барганджия А.Б., Лобастов К.В., 20242024Счастливцев И.В., Козлова В.В., Барганджия А.Б., Лобастов К.В.Schastlivtsev I.V., Kozlova V.V., Bargandzhiya A.B., Lobastov K.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/467

На сегодняшний день антикоагулянтами выбора у пациентов с имплантированным кава-фильтром остаются антагонисты витамина К, в то время как использование прямых оральных антикоагулянтов является спорным вопросом. Цель обзора – сравнить эффективность и безопасность применения прямых оральных антикоагулянтов и антагонистов витамина К у пациентов с имплантированным кава-фильтром. Систематический поиск соответствующих статей проводился в Medline (Pubmed) и Cochrane Library в соответствии с рекомендациями PRISMA. Критериями включения в анализ служили сравнительные исследования любого дизайна с пациентами с наличием инструментально верифицированного венозного тромбоэмболического осложнения и имплантацией кава-фильтра, получавшими длительную терапию с помощью прямых оральных антикоагулянтов или антагонистов витамина К с данными о числе тромботических и геморрагических осложнений и сроком наблюдения ≥3 мес. Основными конечными точками служили рецидив венозного тромбоэмболического осложнения и большое кровотечение. Дополнительными конечными точками являлись тромбоз глубоких вен, тромбоз нижней полой вены или окклюзия кава-фильтра, тромбоэмболия легочной артерии, небольшое, но клинически значимое кровотечение, любое кровотечение и общая смертность. Метаанализ был выполнен с использованием модели случайного или фиксированного эффекта в зависимости от выявленной гетерогенности. В результате поиска литературы, выполненного в июле 2024 г., было обнаружено 189 ссылок, из которых после скрининга и исключения 174 нерелевантных работ отобраны 4 статьи для изучения полнотекстовых версий. В анализ было включено 2 ретроспективных когортных исследования с участием 302 пациентов, сравнивающих применение ривароксабана и варфарина. На фоне приема ривароксабана не наблюдалось достоверных различий по заявленным конечным точкам. Ривароксабан является единственным прямым оральным антикоагулянтом, изученным у пациентов с имплантированным кава-фильтром. Терапия ривароксабаном не менее эффективна и безопасна в сравнении с приемом варфарина после имплантации кава-фильтра.

Nowadays, vitamin K antagonists (VKA) remain the anticoagulants of choice for patients with implanted inferior vena cava (IVC) filters, while the use of direct oral anticoagulants (DOACs) is controversial. Aim of the review – the study aimed to compare the efficacy and safety of DOACs and VKAs in patients with IVC filters. A systematic search for the relevant papers was performed in Medline (Pubmed) and the Cochrane Library according to the PRISMA guidelines. The inclusion criteria for the analysis were as follows: comparative studies of any design that enrolled patients with verified venous thromboembolism (VTE) who underwent IVC filter implantation and received long-term therapy with DOACs or VKAs with reported numbers of thrombotic and hemorrhagic complications within a follow-up of ≥3 months. The primary endpoints were VTE recurrence and major bleeding. Secondary endpoints included deep vein thrombosis (DVT), IVC thrombosis or filter occlusion, pulmonary embolism (PE), clinically relevant non-major (CRNM) bleeding, any bleeding, and all-cause mortality. Meta-analysis was performed using a random or fixed-effect model depending on the identified heterogeneity. As a result of the literature search was performed in July 2024 and identified 189 references, of which four articles were selected for full-text analysis after screening and excluding 174 irrelevant papers. The final qualitative analysis and quantitative synthesis included two retrospective cohort studies of 302 patients comparing rivaroxaban and warfarin. There were no significant differences between rivaroxaban and warfarin according to the prespecified endpoints. Rivaroxaban is the only DOAC studied in patients with IVC filters. Anticoagulation with rivaroxaban is not less effective and safe than with warfarin after IVC filter implantation.

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