Couturaud F, Julian J A, Kearon C
Hamilton Civic Hospitals Research Centre and McMaster University, Ontario, Canada.
Thromb Haemost. 2001 Oct;86(4):980-4.
Low molecular weight heparin is as effective and safe as unfractionated heparin for treatment of acute venous thromboembolism. It is uncertain whether low molecular weight heparin should be administered once-daily or twice-daily in this setting.
A meta-analysis of randomized studies which directly compared once- and twice-daily administration of low molecular weight heparin for the treatment of acute venous thromboembolism was performed. A literature search was performed using Advanced Pub Med and the Cochrane library database, and abstracts from recent meetings were reviewed. Two investigators extracted data independently.
Five studies, involving 1522 patients, were eligible. There were no statistically significant differences in the frequencies of symptomatic (odds ratio, 0.85 in favor of once-daily therapy at three months, p = 0.6), and asymptomatic, recurrent venous thromboembolism, total and major bleeds (odds ratio, 1.16 in favor of twice-daily therapy at 10 days, p = 0.8); and death, at 10 days, as well as at three months of follow-up.
Once-daily low molecular weight heparin appears to be as effective and safe as twice-daily administration for the acute treatment of venous thromboembolism. However, there is inadequate data from studies that directly compared once-daily and twice-daily administration to be able to exclude the possibility of a higher frequency of fatal bleeding with once-daily therapy.
低分子量肝素在治疗急性静脉血栓栓塞方面与普通肝素一样有效且安全。在此情况下，低分子量肝素应每日给药一次还是两次尚不确定。
对直接比较低分子量肝素每日一次和每日两次给药治疗急性静脉血栓栓塞的随机研究进行荟萃分析。使用高级PubMed和Cochrane图书馆数据库进行文献检索，并查阅近期会议的摘要。两名研究人员独立提取数据。
五项研究，涉及1522名患者，符合条件。有症状的（比值比，三个月时每日一次治疗为0.85，p = 0.6）、无症状的、复发性静脉血栓栓塞、总出血和大出血（比值比，10天时每日两次治疗为1.16，p = 0.8）以及10天时和随访三个月时的死亡频率，均无统计学显著差异。
对于静脉血栓栓塞的急性治疗，每日一次低分子量肝素似乎与每日两次给药一样有效且安全。然而，直接比较每日一次和每日两次给药的研究数据不足，无法排除每日一次治疗致命出血频率更高的可能性。
