低分子量肝素与一般和整形外科的标准肝素:一个元分析
M T Nurmohamed1, F R Rosendaal, H R Büller
1Centre for Haemostasis, Thrombosis, Atherosclerosis and Inflammation Research, Academic Medical Centre, Amsterdam, The Netherlands.
Lancet (London, England)
|July 18, 1992
概括
与标准肝素相比,低分子量肝素 (LMWHs) 显示深静脉血栓和肺栓塞的风险降低. 然而,在整体外科手术中改善益处风险比率的证据有限,尽管在骨科手术中可能更喜欢LMWH.
科学领域:
- 药理学和治疗学 药理学和治疗学
- 进行血栓预防治疗.
- 基于证据的医学基于证据的医学.
背景情况:
- 低分子量肝素 (LMWHs) 在预防手术后血栓方面比标准肝素具有理论上的优势.
- 现有的文献表明了潜在的益处,需要对比较研究进行全面审查.
研究的目的:
- 进行一项元分析,比较LMWHs的疗效和安全性与术后血栓预防的标准肝素.
- 评估不同手术群体中LMWHs的益处与风险的比率.
主要方法:
- 1984年至1991年4月期间发表的随机对照试验的元分析.
- 纳入标准:英语,法语或德国研究比较LMWHs和标准肝素在推剂量,使用适当的深静脉血栓瘤查.
- 总体和骨科手术的子组分析,基于方法严格的总体手术的灵敏度分析.
主要成果:
- 总的来说,LMWH与标准肝素相比,对深静脉血栓 (0.74) 和肺栓塞 (0.43) 的相对风险降低,严重出血的风险也相似 (0.98).
- 在整体外科,高质量的研究表明,LMWHs的益处风险比较不利 (DVT RR 0.91,大出血RR 1.32).
- 整形外科的研究表明,与LMWHs一起,静脉血栓形成的绝对风险降低更大.
结论:
- 目前的证据没有令人信服地证明,在一般外科患者中,LMWHs与标准肝素相比,LMWHs的益处与风险比率在临床上有显著改善.
- 由于更大降低静脉血栓形成风险,LMWH可能是骨科手术中血栓预防的首选选择.
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