中国人心脏瓣膜置换术后低强度抗凝治疗的系统评价及文献分析  

A systemic review of low intensity anticoagulation therapy for Chinese population with heart valve replacement

作　　者：董力[1] 石应康[1] 付博[1] 滕晓[2] 陈进[3] 张本贵[1] 

机构地区：[1]四川大学华西医院心血管外科,成都610041 [2]中国医学科学院北京阜外心血管病医院 [3]卫生部中国循证医学中心

出　　处：《中华医学杂志》2014年第34期2673-2676,共4页National Medical Journal of China

基　　金：“十二五”国家科技支撑计划项目（2011BAI11B18）;四川省科技支撑计划项目（2009SZ0207）

摘　　要：目的 系统评价中国人心脏瓣膜置换术后低强度抗凝治疗的疗效和安全性.方法 检索1990年1月至2010月12月中国生物医学数据库（CBM）、中国知网（CNKI）、维普中文科技期刊数据库、PubMed及Cochrane图书馆有关心脏瓣膜置换术后抗凝治疗的中文文献,按纳入及排除标准进行筛选及质量评估,对照研究文献进行荟萃分析,叙述性研究行描述性分析.结果 纳入文献61篇,其中对照研究4篇,叙述性研究57篇.荟萃分析及描述性分析结果均提示,低强度抗凝组的抗凝总并发症发生率及出血率均较传统强度组明显降低（RR=-0.06,95％CI：-0.08～-0.03,P＜0.001;RR=-0.06,95％ CI：-0.08～0.04,P＜0.001）,而两组间栓塞率差异并无统计学意义（RR =0.01,95％ CI：-0.01～0.03,P＞0.05）.结论 心脏瓣膜置换术后低强度抗凝治疗取得了在栓塞并发症发生率无明显增高的基础上,出血并发症发生及死亡率显著降低的成果,该治疗安全、有效,是适合中国人凝血特点的治疗方法.Objective To investigate the safety and efficacy of low intensity anticognlation therapy for chinese population underwent heart valve replacemnt.Methods From January 1999 to October 2010,the literatures concering anticoagulation therapy for chinese population with heart valve replacement were researched in following databases：CBM,CNKI,VIP,Pubmed as well as cochrane library.Screening and quality evaluation was conducted according to the inclusion and exclusion criteria.Meta-analysis of control studies and descriptive analysis of descriptive studies were conducted.Results Total 61 articles were reviewed,including 4 control studies and 57 descriptive studies.Both Meta analysis and descriptive analysis results showed also that the rates of total anticoagulation-related complications as well as bleeding events were significantly decreased in patients receiving low intensity anticoagulation therapy in compared with classical intensity strategy （RR =-0.06,95 ％ CI：-0.08--0.03,P ＜ 0.001 ; RR =-0.06,95 ％ CI：-0.08-0.04,P ＜0.001）,while no significant differeces were noted as for risk of thrmoboembolic events among two different intensity groups（RR =0.01,95％ CI：-0.01-0.03,P ＞0.05）.Conclusions Low intensity anticoagulation therapy（INR ≤2.5） could effectively miminze the anticoagulation-related hemorrhage and mortality rates and while without increasing the rates of thrmoboembolic event.This therapy was safe,effective and suitable for the coagulation characteristics of Chinese population.

关 键 词：心脏瓣膜置换 抗凝治疗 系统评价 荟萃分析 

分 类 号：R654.2[医药卫生—外科学]