在COVID-19的非危急病患者中使用抗凝血策略
Zoe K McQuilten1,2, Balasubramanian Venkatesh3,4,5,6,7, Vivekanand Jha5,8
1Monash University, Melbourne, Australia.
NEJM evidence
|February 6, 2024
概括
住院COVID-19患者的最佳抗凝剂尚不清楚. 中期剂量肝素显示出潜在的益处,但试验结束阻止了对血栓预防疗法的有效性做出最终结论.
科学领域:
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
- 药理学 药理学是指药理学的学科.
背景情况:
- 确定住院冠状病毒病2019 (COVID-19) 患者的最佳血栓预防策略至关重要.
- 之前的研究对最有效的抗凝血方法产生了不确定的结果.
研究的目的:
- 为了比较不同剂量低分子量肝素 (LMWH) 血栓预防的有效性,与或没有阿司匹林,在住院的COVID-19患者.
- 评估治疗剂量抗凝剂在这个患者群体中的影响.
主要方法:
- 一个适应性平台试验随机分配了1574名住院COVID-19成年人接受低剂量LMWH,中剂量LMWH或低剂量LMWH加阿司匹林.
- 阿司匹林手臂被停止使用,并根据新出现的证据添加了治疗剂量手臂.
- 主要终点是28日死亡或需要新的器官支持,使用贝叶斯逻辑模型进行分析.
主要成果:
- 在1526名分析患者中,主要结局发生在5.9% (低剂量),4.2% (中间剂量),7.2% (低剂量+阿司匹林) 和14% (治疗剂量) 的患者中.
- 与低剂量相比,中剂量LMWH具有86%的后期减少主要结果的概率 (OR 0.74,95%的CRI 0.43-1.27).
- 治疗剂量抗凝剂显示有7%的益处概率 (OR2.22,95%CRI 0.77-6.20);整体血栓和出血率较低 (0.8%和0.4%).
结论:
- 中期剂量LMWH在非重症住院COVID-19成年人中表现出86%的可能性比低剂量血栓预防更有效.
- 低剂量LMWH与阿司匹林的益处概率为65%,而治疗剂量抗凝血治疗的益处概率仅为7%.
- 由于运营限制,试验的关闭阻止了对COVID-19患者最佳抗凝策略的最终结论.
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