在没有ST升高的急性冠状动脉综合征中,未分离的氨酸和低分子量氨酸:元分析
J W Eikelboom1, S S Anand, K Malmberg
1Preventive Cardiology and Therapeutics Program, McMaster University, Hamilton, Canada.
Lancet (London, England)
|June 20, 2000
概括
短期使用未分离的氨酸或低分子量氨酸 (LMWH) 显著降低了急性冠状动脉综合征患者死亡或心肌梗塞的风险. 这些肝素之间没有明确的疗效或安全差异,长期LMWH没有额外的益处.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 临床试验 临床试验
背景情况:
- 在没有ST升高的急性冠状动脉综合征的阿司匹林治疗患者中,未分离的氨酸 (UFH) 和低分子量氨酸 (LMWH) 的作用尚不清楚.
- 关于LMWH与UFH的比较疗效和安全性存在相互矛盾的证据.
研究的目的:
- 系统地审查随机试验,评估UFH和LMWH对死亡率,心肌梗塞和在没有ST升高的急性冠状动脉综合征中大出血的影响.
- 为了比较UFH和LMWH的疗效和安全性.
主要方法:
- 12个随机试验的系统概述,涉及17,157名患者.
- 纳入标准:UFH或LMWH与安慰剂/未经治疗的对照,或UFH与LMWH对于没有ST升高的急性冠状动脉综合征.
- 使用修改的曼特尔-汉泽尔方法来计算关键结果的几率比率的元分析.
主要成果:
- 与安慰剂相比,短期的UFH或LMWH (长达7天) 将心肌梗塞或死亡的风险减半 (或0.53).
- 在短期LMWH和UFH (OR0.88) 之间没有观察到有效性的显著差异.
- 长期的LMWH (长达3个月) 与安慰剂相比没有益处 (OR 0.98),并且与严重出血的风险显著增加有关 (OR 2.26).
结论:
- 短期服用UFH或LMWH有效减少阿司匹林治疗急性冠状动脉综合征患者的心肌梗塞或死亡.
- 在短期使用中,UFH和LMWH之间没有发现有效性或安全性的显著差异.
- 长期使用LMWH超过7天没有证据支持,并增加出血风险.
相关概念视频
01:21Chemical Ionization (CI) Mass Spectrometry
The molecular ion peak of a molecule in the mass spectrum provides vital information for molecular identification. However, conventional electron impact ionization can lead to the rapid dissociation of some molecular ions before they reach the detector. A milder ionization method is required to increase the lifetime of such ionized analyte molecules. Chemical ionization (CI) is a gas-phase protonation reaction useful for mass-analyzing analyte molecules that are easily protonated to yield the...
01:01Mass Spectrometry: Carboxylic Acid, Ester, and Amide Fragmentation
The fragmentation patterns observed for compounds such as carboxylic acids, esters, and amides in the mass spectra include ⍺-cleavage and McLafferty rearrangement. Fragmentation by ⍺-cleavage preferentially occurs at the carbon-carbon bond at the ⍺-position next to the carboxylic group to generate a neutral radical and a cation. Long chain compounds with hydrogen at their γ-carbon undergo McLafferty rearrangement to give a radical cation and a neutral alkene.
For example, the fragmentation of...
For example, the fragmentation of...
01:24Diagnosing Acidosis and Alkalosis
Diagnosing acid-base imbalances involves systematically analyzing arterial blood samples, focusing on three key measurements: pH, bicarbonate (HCO3−) concentration, and carbon dioxide partial pressure (PCO2). This analysis follows a four-step process that helps identify the imbalance's underlying cause and nature.
First, the pH level is assessed to determine whether the blood pH is normal (7.35–7.45), low (acidosis), or high (alkalosis).
Next, the PCO2 and HCO3− values are examined to...
First, the pH level is assessed to determine whether the blood pH is normal (7.35–7.45), low (acidosis), or high (alkalosis).
Next, the PCO2 and HCO3− values are examined to...
01:30Acute Coronary Syndrome I: Introduction
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...
01:30Acute Coronary Syndrome III: Diagnostic Studies
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...