孕妇使用机械心脏门的抗凝药:对系统性审查的方法审查
Rizwana Ashraf1, Lauren Clarfield2, Shahab Sayfi3
1Department of Obstetrics and Gynaecology, McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Canada.
The Canadian journal of cardiology
|February 1, 2026
概括
对怀孕期间机械心脏门的抗凝药的系统审查显示了重大质量问题. 为指导临床决策提供了对母亲和胎儿后果的可靠风险估计.
科学领域:
- 心脏病学 心脏病学
- 产科 产科 产科 产科 产科
- 基于证据的医学基于证据的医学.
背景情况:
- 具有机械心脏门 (MHV) 的孕妇需要抗凝药.
- 系统性审查 (SRs) 评估怀孕期间MHVs的抗凝血剂策略有方法上的差异.
- 对临床结果的准确风险估计对于患者管理至关重要.
研究的目的:
- 描述在怀孕期间对MHVs的抗凝血药物SR的方法变化.
- 为临床结果提供最可靠的风险估计.
- 为临床实践指南和共享决策提供信息.
主要方法:
- 在八个数据库中搜索了符合条件的SRs.
- 使用测量工具来评估系统性审查 (AMSTAR-2) 批判性地评估SR质量.
- 使用电子搜索策略同行评审 (PRESS) 准则评估搜索策略.
- 使用自定义检查列表评估元分析方法.
- 使用算法确定可靠的风险估计,考虑AMSTAR-2分数,搜索质量和最新情况.
主要成果:
- 大多数 (9/12) 的SR质量极低 (AMSTAR-2).
- 在4个公布了搜索策略的SR中,有3个质量低 (PRESS).
- 分析方法显示了很大的差异.
- 提供了可靠的风险估计,对孕产妇死亡率,血栓栓塞,胎儿损失,和先天异常的VKAs,顺序治疗,和LMWH.
结论:
- 关于MHV孕妇抗凝药的SR在质量和方法上表现出相当大的异质性.
- 提供的风险估计为临床实践和患者咨询提供了有价值的数据.
- 解决未来SR中的方法限制对于产生强有力的证据至关重要.
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