现在的meta分析可以说遭到很多临床医生、研究生、博士嫌弃，因为有很多人都不学习了，可能是单位原因（不承认），也可能是老板（不准发meta）原因，也可能是个人原因（现在流行生信数据挖掘，临床数据挖掘）。也不是说meta分析没有用，meta分析是有用的，只是很多人用的地方不对或者滥用。例如你提出的问题，然后用meta分析解决了，这是很多人都关心的问题，很多人都想有这样的证据出来，已解决实际的临床问题，或者论证自己的观点或者作报告，如果是这种情况，你写的meta分析肯定是受欢迎的，高分期刊也很喜欢发表这样的文章。现在很多人写的meta都是除了自己关心外，再也找不到第二个人关心这个问题，也没有第二个人愿意来看。这样的文章一般是发不出去或者填补OA期刊冗余的版面。现在我们来来看看这篇27分的meta分析，这篇文章发表在BMJ上，文章题目如下：Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked venous thromboembolism event: systematic review and meta-analysis作者研究的是第一次无端静脉血栓栓塞患者停用抗凝治疗后第一次复发性静脉血栓栓塞事件发生率，以及复发性静脉血栓栓塞长达10年的累积发病率。作者就是做率的meta，文章全文只有两张图：AbstractObjectives To determine the rate of a first recurrent venous thromboembolism (VTE) event after discontinuation of anticoagulant treatment in patients with a first episode of unprovoked VTE, and the cumulative incidence for recurrent VTE up to 10 years.Design Systematic review and meta-analysis.Data sources Medline, Embase, and the Cochrane Central Register of Controlled Trials (from inception to 15 March 2019).Study selection Randomised controlled trials and prospective cohort studies reporting symptomatic recurrent VTE after discontinuation of anticoagulant treatment in patients with a first unprovoked VTE event who had completed at least three months of treatment.Data extraction and synthesis Two investigators independently screened studies, extracted data, and appraised risk of bias. Data clarifications were sought from authors of eligible studies. Recurrent VTE events and person years of follow-up after discontinuation of anticoagulant treatment were used to calculate rates for individual studies, and data were pooled using random effects meta-analysis. Sex and site of initial VTE were investigated as potential sources of between study heterogeneity.Results 18 studies involving 7515 patients were included in the analysis. The pooled rate of recurrent VTE per 100 person years after discontinuation of anticoagulant treatment was 10.3 events (95% confidence interval 8.6 to 12.1) in the first year, 6.3 (5.1 to 7.7) in the second year, 3.8 events/year (95% confidence interval 3.2 to 4.5) in years 3-5, and 3.1 events/year (1.7 to 4.9) in years 6-10. The cumulative incidence for recurrent VTE was 16% (95% confidence interval 13% to 19%) at 2 years, 25% (21% to 29%) at 5 years, and 36% (28% to 45%) at 10 years. The pooled rate of recurrent VTE per 100 person years in the first year was 11.9 events (9.6 to 14.4) for men and 8.9 events (6.8 to 11.3) for women, with a cumulative incidence for recurrent VTE of 41% (28% to 56%) and 29% (20% to 38%), respectively, at 10 years. Compared to patients with isolated pulmonary embolism, the rate of recurrent VTE was higher in patients with proximal deep vein thrombosis (rate ratio 1.4, 95% confidence interval 1.1 to 1.7) and in patients with pulmonary embolism plus deep vein thrombosis (1.5, 1.1 to 1.9). In patients with distal deep vein thrombosis, the pooled rate of recurrent VTE per 100 person years was 1.9 events (95% confidence interval 0.5 to 4.3) in the first year after anticoagulation had stopped. The case fatality rate for recurrent VTE was 4% (95% confidence interval 2% to 6%).Conclusions In patients with a first episode of unprovoked VTE who completed at least three months of anticoagulant treatment, the risk of recurrent VTE was 10% in the first year after treatment, 16% at two years, 25% at five years, and 36% at 10 years, with 4% of recurrent VTE events resulting in death. These estimates should inform clinical practice guidelines, enhance confidence in counselling patients of their prognosis, and help guide decision making about long term management of unprovoked VTE.Systematic review registration PROSPERO CRD42017056309.
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