ST上昇のない急性冠動脈症候群における未分化ヘパリンと低分子量ヘパリン:メタ解析
J W Eikelboom1, S S Anand, K Malmberg
1Preventive Cardiology and Therapeutics Program, McMaster University, Hamilton, Canada.
Lancet (London, England)
|June 20, 2000
まとめ
断片化されていないヘパリンまたは低分子量ヘパリン (LMWH) の短期的な使用は,急性冠動脈症候群の患者の死亡または心筋梗塞のリスクを大幅に低下させます. これらのヘパリンとの間に明確な有効性または安全性の違いは存在せず,長期的なLMWHは追加の利益を提供しません.
科学分野:
- 心臓病学 心臓病学
- 薬理学 薬理学とは
- クリニック・トライアル 臨床試験
背景:
- ST上昇なしの急性冠動脈症候群でアスピリンを投与された患者における未分化ヘパリン (UFH) と低分子量ヘパリン (LMWH) の役割はよく定義されていません.
- LMWHとUFHの比較効果と安全性に関して,矛盾する証拠が存在する.
研究 の 目的:
- ST上昇のない急性冠動脈症候群における死亡率,心筋梗塞,大出血に対するUFHとLMWHの影響を評価するランダム化試験を体系的にレビューする.
- UFHとLMWHの有効性および安全性プロフィールを比較する.
主な方法:
- 17157人の患者が参加した12件のランダム化試験の体系的概要.
- 含有基準:UFHまたはLMWH対プラセボ/未治療対照群,またはST上昇のない急性冠動脈症候群のUFH対LMWH.
- 変更されたMantle-Haenszel方法を用いたメタアナリシスで,主要結果のオッズ比率を計算した.
主要な成果:
- 短期的なUFHまたはLMWH (7日間まで) は,プラセボと比較して心筋梗塞または死亡のリスクを半減しました (OR 0.53).
- 短期的なLMWHとUFH (OR 0.88) の間に有効性の有意な違いは観察されなかった.
- 長期のLMWH (3ヶ月まで) はプラセボ (OR 0.98) よりも効果を示せず,大出血のリスク (OR 2.26) の有意な増加と関連していました.
結論:
- UFHまたはLMWHの短期投与は,アスピリンを服用している急性冠動脈症候群患者の心筋梗塞または死亡を減らすのに有効です.
- 短期使用におけるUFHとLMWHの有効性または安全性の有意な違いは見つかりませんでした.
- 7日以上のLMWHの長期使用は,証拠によって支持されず,出血のリスクを高めます.
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