替罗非班诱导重度血小板减少或出血危险因素的系统评价.

BJECTIVE: To systematically evaluate the risk factors for severe thrombocytopenia or bleeding induced by tirofiban.METHODS: PubMed,EMBase,the Cochrane Library,CNKI,CBM,Wanfang and VIP database were retrieved to collect the literature of risk factors for severe thrombocytopenia or bleeding induced by tirofiban.The retrieval time was from the establishment of the database to Feb. 2020. Two researchers independently screened the literature according to the inclusion and exclusion criteria,extracted the data and evaluated the quality. RevMan 5. 3 software was used for Meta-analysis. RESULTS: A total of 10 literature were included,including 2 foreign language literature and 8 Chinese literature,and 10 141 patients were enrolled.A total of 13 exposure factors were screened out.The univariate Meta-analysis results showed that patients’ old age (MD = 6. 23,95% CI = 4. 58-7. 88),emergency percutaneous coronary intervention (OR = 3. 48,95%CI = 2. 25-5. 38),hypertension (OR = 1. 37,95%CI = 1. 08-1. 72),reduced platelet aggregation rate (MD =-8. 91,95% CI =-11. 17--6. 66),reduced platelet count (MD =-21. 93,95%CI =-32. 81--11. 04),reduced serum creatinine (MD = 10. 01,95% CI = 1. 75-18. 27),reduced creatinine clearance (MD =-32. 16,95% CI =-36. 06--28. 25),reduced glomerular filtration rate (MD =-15. 19,95% CI =-19. 11--11. 26) and the combined application of multiple anticoagulants (OR = 0. 89,95%CI = 0. 53-1. 25) were risk factors for severe thrombocytopenia or bleeding induced by tirofiban (P ＜ 0. 05) . Multivariate Meta-analysis results showed that old age (＞65 years),hypertension,emergency percutaneous coronary intervention and reduced glomerular filtration rate (＜60 ml/min) were independent risk factors for severe thrombocytopenia or bleeding induced by tirofiban (P＜ 0. 01) . The results of sensitivity analysis indicated that the stability of the results was good. CONCLUSIONS:Patients should be alert to severe thrombocytopenia or bleeding when using tirofiban. For patients with risk factors,individualized evaluation should be carried out in advance to reduce the occurrence of adverse drug reactions. [ABSTRACT FROM AUTHOR]