对于接受长期血液透析的人来说,抗凝药
Patrizia Natale1,2,3, Suetonia C Palmer4, Marinella Ruospo3
1Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari Aldo Moro, Bari, Italy.
The Cochrane database of systematic reviews
|January 8, 2024
概括
血液透析 (HD) 的抗凝血药物对电路凝血和出血有不确定的风险. 区域酸盐可能会减少轻微出血,但证据质量较低,无法指导临床决策.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 药理学 药理学是指药理学的学科.
- 临床试验 临床试验
背景情况:
- 血液透析 (HD) 需要安全的抗凝剂,以防止电路凝血和出血并发症.
- 低分子量肝素 (LMWH) 与未分离肝素 (UFH) 相比,具有潜在的优势,但存在积累和出血的风险.
研究的目的:
- 评估各种抗凝血策略的疗效和安全性,用于长期的HD在功能衰竭患者.
- 包括在没有全身抗凝药的情况下预防电路凝血的干预措施,如区域酸盐和氨酸涂层透析剂.
主要方法:
- 进行了随机对照试验 (RCT) 和准RCT的系统审查.
- 评估偏差风险和提取数据;执行随机效应元分析.
- 使用GRADE方法评估证据确定性.
主要成果:
- 包括113项研究与4535名参与者;大多数研究具有高或不清楚的偏见风险.
- LMWH对电路血栓形成与UFH有不确定的影响;出血数据不足.
- 区域酸盐可能会减少轻微出血与UFH相比,但缺乏关于重大出血和血栓形成的数据.
结论:
- 关于UFH和LMWH对电路血栓塞和出血的比较风险仍然不确定.
- 区域酸盐可能会减少轻微出血,但其对重大出血和血栓形成的影响未报告.
- 低确定性证据限制了对HD抗凝策略的临床决策.
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