Mismetti P, Laporte-Simitsidis S, Tardy B, Cucherat M, Buchmüller A, Juillard-Delsart D, Decousus H
Clinical Pharmacology Unit, University Hospital of Saint-Etienne, France.
Thromb Haemost. 2000 Jan;83(1):14-9.
The prevention of venous thromboembolic disease is less studied in medical patients than in surgery.
We performed a meta-analysis of randomised trials studying prophylactic unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) in internal medicine, excluding acute myocardial infarction or ischaemic stroke. Deep-vein thrombosis (DVT) systematically detected at the end of the treatment period, clinical pulmonary embolism (PE), death and major bleeding were recorded.
Seven trials comparing a prophylactic heparin treatment to a control (15,095 patients) were selected. A significant decrease in DVT and in clinical PE were observed with heparins as compared to control (risk reductions = 56% and 58% respectively, p <0.001 in both cases), without significant difference in the incidence of major bleedings or deaths. Nine trials comparing LMWH to UFH (4,669 patients) were also included. No significant effect was observed on either DVT, clinical PE or mortality. However LMWH reduced by 52% the risk of major haemorrhage (p = 0.049).
This meta-analysis, based on the pooling of data available for several heparins, shows that heparins are beneficial in the prevention of venous thromboembolism in internal medicine.
与外科手术患者相比，医学患者静脉血栓栓塞性疾病的预防研究较少。
我们对在内科使用普通肝素（UFH）或低分子肝素（LMWH）进行预防的随机试验进行了荟萃分析，排除急性心肌梗死或缺血性中风。记录治疗期结束时系统检测到的深静脉血栓形成（DVT）、临床肺栓塞（PE）、死亡和大出血情况。
选择了7项将肝素预防性治疗与对照进行比较的试验（15095例患者）。与对照相比，肝素治疗组的DVT和临床PE显著减少（风险降低分别为56%和58%，两种情况p均<0.001），大出血或死亡发生率无显著差异。还纳入了9项比较LMWH与UFH的试验（4669例患者）。未观察到对DVT、临床PE或死亡率有显著影响。然而，LMWH使大出血风险降低了52%（p = 0.049）。
基于几种肝素可用数据汇总的这项荟萃分析表明，肝素在内科预防静脉血栓栓塞方面是有益的。
