不同低分子肝素预防房颤患者血栓性疾病有效性和安全性的网状Meta分析  

Efficacy and safety of different low-molecular-weight heparins in preventing thrombotic disease in patients with atrial fibrillation: a network meta-analysis

作　　者：陈林华 周凌云[1] 李典坷 汪江林[1] 尹文俊[1] 刘昆 周格 方伟进 左笑丛[1] CHEN Linhua;ZHOU Lingyun;LI Dianke;WANG Jianglin;YIN Wenjun;LIU Kun;ZHOU Ge;FANG Weijin;ZUO Xiaocong(Department of Pharmacy,the Third Xiangya Hospital of Central South University,Changsha 410013,P.R.China)

机构地区：[1]中南大学湘雅三医院药学部,长沙410013

出　　处：《中国循证医学杂志》2021年第10期1154-1161,共8页Chinese Journal of Evidence-based Medicine

基　　金：国家自然科学基金项目(编号:81973400);湖南省医学会科研基金临床药学重点项目(编号:HMA202001003);湖南省卫生健康委科研计划课题项目(编号:B2019169)。

摘　　要：目的系统评价不同品种低分子肝素(LMWHs)在房颤患者中预防血栓性疾病的有效性和安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、CBM、CNKI、VIP和WanFang Data数据库,搜集房颤患者使用LMWHs预防血栓性疾病有效性和安全性的随机对照试验(RCT),检索时限均为建库至2021年3月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 16.0软件进行网状Meta分析。结果共纳入11个RCT,包括7 400例患者,LMWHs品种包括依诺肝素、达肝素和亭扎肝素。间接比较网状Meta分析结果显示,在房颤患者和围术期房颤患者中,达肝素、依诺肝素和亭扎肝素对患者卒中发生率、短暂性脑缺血发作(TIA)发生率、主要出血发生率、小出血发生率和全因死亡发生率的差异均无统计学意义。累积排序概率图下面积(SUCRA)显示,依诺肝素在降低卒中发生率和TIA率方面优于达肝素和亭扎肝素;但使用达肝素的患者发生主要出血、小出血和全因死亡的风险可能低于依诺肝素。结论当前有限证据显示,依诺肝素对具有LMWHs使用指征的高缺血风险房颤患者可能是最优选择,高出血风险患者可考虑首选达肝素治疗。受纳入研究数量和质量限制,上述结论尚待更多高质量研究予以验证。Objective To systematically review the efficacy and safety of different low-molecular-weight heparins(LMWHs) for prevention of thromboembolic events in patients with atrial fibrillation(AF). Methods PubMed, The Cochrane Library, EMbase, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized clinical trials(RCTs) on efficacy and safety of different low-molecular-weight heparins(LMWHs) in preventing thrombotic diseases in patients with atrial fibrillation from inception to March 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies;then, meta-analysis was performed by using Stata 16.0 software. Results A total of 11 RCTs involving 7 400 patients who were treated with enoxaparin, dalteparin, or tinzaparin to prevent thromboembolic events were included. The results of network metaanalysis showed that: in patients with AF and perioperative AF patients, there were no statistical differences in the incidence of stroke, TIA, major bleeding, minor bleeding, and all-cause mortality caused by dalteparin, enoxaparin, and tinzaparin. Furthermore, the surface under the cumulative ranking area(SUCRA) showed that enoxaparin was superior for prevention of stroke and TIA than dalteparin and tinzaparin. As for major bleeding, minor bleeding, and all-cause death, dalteparin treatment was superior than enoxaparin. Conclusions Current evidence showed enoxaparin to be a viable option for high ischemic risk AF patients requiring LWMH treatment, while dalteparin to be a viable option for those with bleeding high risk. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.

关 键 词：房颤 血栓性疾病 低分子肝素 网状Meta分析 随机对照试验 

分 类 号：R541.75[医药卫生—心血管疾病]