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在COVID-19的门诊症状患者中进行初级血栓预防:随机对照试验的系统审查和元分析
Davide Di Vece1,2,3, Marco Valgimigli4, Elliot Barnathan5
1Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.
Research and practice in thrombosis and haemostasis
|December 19, 2024
概括
在COVID-19门诊患者的初级血栓预防减少了静脉血栓栓塞,但没有影响住院治疗或死亡率. 低绝对风险降低表明常规使用可能不合理.
科学领域:
- 医学 医学 医学 医学 医学
- 药理学 药理学 是一个学科.
- 公共卫生 公共卫生
背景情况:
- 由于COVID-19的流行,需要制定策略来改善患者的治疗结果,特别是在门诊机构.
- 血栓栓塞栓事件是COVID-19患者的一个重大问题.
- 确定门诊患者的有效预防措施至关重要.
研究的目的:
- 评估诊断为COVID-19的门诊患者初级血栓预防的疗效和安全性.
- 评估预防性抗凝药对该人群临床结果的影响.
主要方法:
- 按照PRISMA指南进行系统审查和元分析.
- 在主要数据库 (PubMed,ClinicalTrials.gov,Embase,CENTRAL) 进行全面的文献搜索,截至2023年12月.
- 包括7项随机对照试验,涉及3758名COVID-19症状的门诊患者,将预防性抗凝剂与安慰剂或标准护理进行比较.
主要成果:
- 血栓预防没有显著改变因任何原因住院或死亡率 (RR 1.00;95% CI 0.77-1.31).
- 观察到静脉血栓塞栓症 (VTE) 的显著减少 (RR 0.28;95% CI 0.08-0.94),代表0.6%的绝对风险降低.
- 预防一次静脉瘤事件所需治疗 (NNT) 的数量为174.
结论:
- 在有症状的COVID-19门诊患者中,初级血栓预防有效降低了静脉血栓栓塞的风险.
- 治疗对30天内住院或死亡率没有显著影响.
- 温和的VTE绝对风险降低表明,所有COVID-19门诊患者的常规血栓预防可能不会得到普遍支持.
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