在COVID-19中进行血栓预防. 新的证据提供了新的证据
R Ferrandis1, P Sierra2, A Gomez-Luque3
1Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitari i Politècnic La Fe, SEDAR, Valencia, Spain; SEDAR Haemostasis, Transfusion Medicine and Fluid Therapy Division, Valencia, Spain.
Revista espanola de anestesiologia y reanimacion
|September 7, 2023
概括
标准剂量低分子量肝素 (LMWH) 建议用于严重病情的COVID-19患者. 建议治疗性LMWH剂量用于低出血风险的非危急性住院患者,更新治疗指南.
科学领域:
- 内部医学 内部医学
- 血液学 血液学 血液学
- 传染性疾病 传染性疾病
背景情况:
- 最近的研究质疑低分子量肝素 (LMWH) 的中间或治疗剂量对COVID-19患者的有效性,特别是严重病例.
- 现有的治疗指南需要根据当前证据对LMWH在COVID-19管理中的有效性进行更新.
研究的目的:
- 进行非系统性审查,更新关于在COVID-19患者中使用LMWH的建议.
- 分析LMWH和其他抗凝血剂/抗血小板剂在不同COVID-19患者层中的疗效.
主要方法:
- 进行了对主要医疗数据库的非系统性审查.
- 包括14个随机临床试验,14个元分析和12个科学协会的建议.
- 数据按患者类型分层:门诊,住院,重症监护和出院后.
主要成果:
- 在重症住院COVID-19患者的血栓预防中,建议使用标准LMWH剂量.
- 如果出血风险低,建议对非危急住院的患者使用治疗性LMWH剂量.
- 在门诊患者/出院患者中,可以使用预防性LMWH剂量,这些患者具有血栓风险因素和低出血风险.
结论:
- 该研究提供了针对在不同COVID-19患者群体中使用LMWH的最新建议.
- 通常不建议使用抗血小板药物和LMWH的联合治疗,除非有具体指示.
- 证据支持根据患者的严重程度和出血风险量身定制的LMWH剂量策略.
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