预防性抗凝剂用于COVID-19的非住院患者
Brena C Santos1, Ronald Lg Flumignan1,2, Vinicius T Civile2,3
1Department of Surgery, Division of Vascular and Endovascular Surgery, Universidade Federal de São Paulo, São Paulo, Brazil.
The Cochrane database of systematic reviews
|August 17, 2023
概括
预防性抗凝剂可能会降低非住院COVID-19患者的静脉血栓栓塞 (VTE) 和肺栓塞 (PE),死亡率或严重出血几乎没有差异. 需要进一步的研究才能得出最终的结论.
科学领域:
- 内部医学 内部医学
- 心脏病学 心脏病学
- 传染性疾病 传染性疾病
背景情况:
- COVID-19大流行加剧了人们对血栓栓塞并发症的担忧,尤其是感染个体的静脉血栓塞栓症 (VTE).
- 抗凝剂用于预防血栓形成,在非住院COVID-19患者中减少血管事件和死亡率方面具有潜在的益处.
- 副作用的风险,如出血,需要仔细考虑在这个人群中预防性抗凝剂的使用.
研究的目的:
- 评估与安慰剂相比,预防性抗凝剂的益处和危害,没有干预,活性比较剂,或非药物干预在非住院COVID-19患者.
- 评估预防性抗凝剂对死亡率,静脉动脉突发症和出血事件的影响.
主要方法:
- 进行了随机对照试验 (RCT) 的系统审查和元分析.
- 包括的研究比较了预防性抗凝剂与安慰剂,没有治疗,其他活性比较剂或非药物干预在非住院COVID-19患者.
- 主要结局包括全因死亡率,VTE (深静脉血栓症[DVT]或肺栓塞[PE]) 和严重出血. 证据的确定性使用GRADE进行评估.
主要成果:
- 与安慰剂 (低确定性证据) 相比,预防性抗凝剂在全因死亡率和严重出血方面几乎没有差异.
- 中等确定性证据表明,与安慰剂相比,预防性抗凝剂可能会降低静脉瘤发病率 (从3%降至1%) 和PE风险 (从2.7%降至0.7%).
- 与安慰剂相比,没有观察到DVT,需要住院治疗或不良事件的显著差异. 对于与不同剂量的抗凝血剂或抗血小板剂进行比较的数据有限.
结论:
- 预防性抗凝剂可能会减少非住院COVID-19患者的VTE和PE,有中等确定性的证据.
- 有证据表明,与安慰剂相比,严重出血,DVT,住院或不良事件的差异很小或不存在.
- 需要进行进一步的长期试验,以确定预防性抗凝剂在该人群中的临床作用.
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