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抗脂抗体综合征的管理:系统性审查
Wendy Lim1, Mark A Crowther, John W Eikelboom
1Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
JAMA
|March 2, 2006
概括
中等强度的华法林有效地预防抗脂抗体综合征 (APS) 中的复发性血栓形成. 阿司匹林在特定情况下也有效预防中风,但对于APS的其他血栓风险需要进一步研究.
科学领域:
- 类风湿病学 类风湿病学
- 血液学 血液学 血液学
- 产科 产科 产科 产科 产科
背景情况:
- 抗脂抗体向与脂结合的蛋白质.
- 抗脂抗体综合征 (APS) 将这些抗体与血栓形成或妊娠并发症联系起来.
- 患有APS的患者面临复发性动脉/静脉血栓形成或流产的风险增加.
研究的目的:
- 系统地审查关于治疗具有抗脂抗体或APS的患者血栓形成风险的证据.
- 评估APS患者中血栓事件的当前治疗策略.
主要方法:
- 在MEDLINE和Cochrane图书馆数据库中进行了系统的文献搜索 (截至2005年11月).
- 包括随机试验,元分析和前性队列研究,与APS中血栓形成风险治疗相关.
- 根据证据综合的临床相关性选择的研究.
主要成果:
- 与安慰剂相比,中度强度的华法林 (INR 2.0-3.0) 显著减少了80-90%的复发性静脉血栓形成.
- 华法林也可能有效预防复发性动脉血栓形成;高强度华法林没有显示任何额外益处.
- 阿司匹林和中度强度的华法林在预防先前中风和单次阳性抗脂抗体测试患者的复发中风方面表现出同等的有效性.
结论:
- 中等强度的华法林是预防APS中复发性静脉和潜在的动脉血栓的有效治疗方法.
- 阿司匹林在特定的患者亚组中,在预防复发性中风方面具有与华法林相似的疗效.
- 需要进一步进行精心设计的前性研究,以确定APS的其他血栓性表现的最佳治疗方法.
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