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系统性血栓溶解与较新的血栓抑制剂与急性中间风险肺栓塞中的抗凝剂:系统性审查和元分析
Don Mathew1, Susmitha Seelam2, Karandeep Bumrah2
1Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA. mathewd@upmc.edu.
BMC cardiovascular disorders
|September 28, 2023
概括
系统性血栓溶解与中等风险肺栓塞 (PE) 的抗凝剂对死亡率或重大出血没有差异. 然而,血栓溶解减少了血管压缩剂的使用和救援治疗的需要,但增加了内出血的风险.
科学领域:
- 心脏病学 心脏病学
- 肺部医学 肺部医学
- 关键护理医学 关键护理医学
背景情况:
- 随机对照试验 (RCT) 将系统性血栓溶解与中等风险肺栓塞 (PE) 中的抗凝药进行比较,产生了不同的结果.
- 之前的一项元分析存在局限性,包括使用低于最佳的血栓溶解剂量和过时的药物,限制了其当代相关性.
- 这项研究解决了使用当前证据进行更新元分析的需要.
研究的目的:
- 进行系统性审查和对评估系统性血栓溶解的RCT的元分析,使用现代药物对抗中等风险PE中的抗凝剂进行评估.
- 综合目前关于系统性血栓溶解在这个患者群体中的有效性和安全性的证据.
主要方法:
- 系统性审查和元分析遵循系统性审查和元分析 (PRISMA) 首选报告项目声明.
- 包括九项随机对照试验,比较中等风险PE中全身血栓溶解与抗凝药.
- 对住院死亡率,严重出血,血管压缩剂使用,二次血栓溶解和内出血的统计分析.
主要成果:
- 在住院死亡率 (RR:0.79;95% CI:0.42-1.50) 或重大出血的整体风险 (RR:2.08;95% CI:0.98-4.42) 中没有发现显著差异.
- 系统性血栓溶解与使用血管压缩剂 (RR:0.27;95% CI:0.11-0.64) 和二次/救援血栓溶解 (RR:0.25;95% CI:0.14-0.45) 的风险降低有关.
- 系统性血栓溶解时观察到内出血的风险增加 (RR: 4.55;95% CI: 1.30-15.91).
结论:
- 在中等风险PE中,全身血栓溶解与抗凝剂在住院死亡率或重大出血方面没有区别.
- 系统性血栓溶解可能会减少对血管压缩剂和救援疗法的需要,但会增加内出血的风险.
- 这些发现为管理中等风险PE的临床决策提供了关键的见解.
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