ObjectivesTo systematically review the efficacy and safety of direct oral anticoagulants (DOAC) on preventing venous thromboembolism (VTE) after major orthopedic surgery (MOS).MethodsThe Cochrane Library, PubMed, EMbase, CNKI, WanFang Data and CBM databases were electronically searched for randomized controlled trials (RCTs) on the efficacy and safety of DOAC on preventing VTE after MOS from inception to March 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 22 RCTs involving 41 244 patients were included. The results of meta-analysis showed that: the rate of symptomatic deep vein thrombosis (DVT) after MOS in rivaroxaban (Peto OR=0.54, 95%CI 0.35 to 0.82, P=0.004) and apixaban (Peto OR=0.49, 95%CI 0.26 to 0.92, P=0.03) were lower than enoxaparin. Additionally, the rate of symptomatic pulmonary embolism (PE) after MOS in rivaroxaban was lower than enoxaparin (Peto OR=0.53, 95%CI 0.29 to 0.96, P=0.04), however, in major bleeding after MOS rivaroxaban was significant higher than enoxaparin (Peto OR=1.98, 95%CI 1.30 to 3.01, P=0.001).ConclusionsCurrent evidence shows that rivaroxaban and apixaban is superior to enoxaparin on preventing symptomatic DVT after MOS. Rivaroxaban is superior to enoxaparin on preventing symptomatic PE, however, the risk of major bleeding is higher than enoxaparin. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusions.
ObjectivesTo systematically review the efficacy and safety of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor on hypercholesteremia.MethodsDatabases including The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data and CBM were searched electronically for randomized controlled trials (RCTs) of PCSK9 inhibitor on the treatment of hypercholesteremia from inception to June 2019. Two reviewers independently screened literatures, extracted data, and assessed risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software.ResultsA total of 42 RCTs involving 90 058 patients were included. Alirocumab, evolocumab, bococizumab and LY3015014 were retrieved. Placebo, statin or ezetimibe were used to treat the patient in the control group. The efficacy results showed that there were significant differences between alirocumab combined statin and placebo combined statin (MD=−49.89, 95%CI −56.34 to −43.44, P<0.00001) or evolocumab combined statin and placebo combined statin (MD=−56.54, 95%CI −61.09 to −52.00, P<0.00001) in reducing LDL-C levels. There was significant difference between alirocumab combined statin and ezetimibe combined statin (MD=−29.41, 95%CI −36.08 to −22.75, P<0.00001) in reducing LDL-C levels. The results of Safety showed that there were no significant differences between alirocumab and placebo (RR=0.99, 95%CI 0.97 to 1.01, P=0.37) or evolocumab and placebo (RR=1.05, 95%CI 1.00 to 1.10, P=0.07) in the incidence of adverse events (AEs). There was significant difference between bococizumab and placebo (RR=1.09, 95%CI 1.01 to 1.18, P=0.03) in the incidence of AEs. There was significant difference between evolocumab and ezetimibe (RR=0.89, 95%CI 0.80 to 0.99, P=0.04) in the incidence of AEs. There was no significant difference between alirocumab and statin (RR=0.93, 95%CI 0.84 to 1.03, P=0.90) in the incidence of AEs.ConclusionsPCSK9 inhibitor can reduce LDL-C levels in patients with hypercholesterolemia and has good safety. Due to the limitation of the quantity and quality of the included studies, the above conclusions are needed to be verified by more high quality studies.