Vardi Moshe, Zittan Eran, Bitterman Haim
Internal Medicine, Carmel Medical Center, 7 Michal St, Haifa, Haifa, Israel, 34362.
Cochrane Database Syst Rev. 2009 Oct 7(4):CD006771. doi: 10.1002/14651858.CD006771.pub2.
Venous thromboembolism is a prevalent condition with potentially dire consequences. Its medical treatment requires anticoagulation, which is usually achieved with either unfractionated or low molecular weight heparin (LMWH). Unfractionated heparin (UFH) is usually administered intravenously, but can be applied subcutaneously as well.
To explore the effectiveness of subcutaneous UFH for the initial treatment of venous thromboembolism compared with other treatment modalities.
The Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched 14 July 2009) and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched The Cochrane Library 2009, Issue 3). We searched MEDLINE and EMBASE (last searched February 2009).
Randomised controlled trials, in which treatment with subcutaneous UFH was compared to control, such as subcutaneous LMWH continuous intravenous UFH in patients with acute venous thromboembolism.
Two review authors independently extracted data and assessed trial quality.
Fifteen randomised controlled trials were included with a total of 3054 participants (1475 patients in the intervention group and 1579 patients in the control group). The results for all the major outcomes were statistically non-significant. The odds ratio (OR) for recurrent deep vein thrombosis (DVT) or pulmonary embolism (PE) during three months follow up were 1.68 (95% confidence interval (CI) 0.92 to 3.04) and 1.18. (95% CI 0.54 to 2.56), favouring the control arm. The odds ratio for developing PE during heparin treatment also favoured the control group (OR 1.10, 95% CI 0.46 to 2.62). The ORs for major bleeding during heparin treatment and throughout three months follow up were non significant (1.07, 95% CI 0.64 to 1.79, and 0.66, 95% CI 0.33 to 1.32, respectively). Disease or treatment related deaths as well as total mortality during heparin treatment and at three months follow up did not differ between study groups.
AUTHORS' CONCLUSIONS: Subcutaneous unfractionated heparin for the treatment of venous thromboembolism cannot be considered non-inferior to other treatment modalities in terms of recurrent DVT and PE at three months, but seems as safe and effective with regards to rates of major bleeding and death.
静脉血栓栓塞是一种常见疾病，可能会导致严重后果。其药物治疗需要进行抗凝，通常使用普通肝素或低分子肝素（LMWH）来实现。普通肝素（UFH）通常通过静脉注射给药，但也可以皮下注射。
探讨皮下注射UFH与其他治疗方式相比，用于静脉血栓栓塞初始治疗的有效性。
Cochrane外周血管疾病小组检索了他们的专业注册库（最后检索时间为2009年7月14日）和Cochrane对照试验中心注册库（CENTRAL）（最后检索时间为《Cochrane图书馆》2009年第3期）。我们检索了MEDLINE和EMBASE（最后检索时间为2009年2月）。
随机对照试验，其中将皮下注射UFH的治疗与对照组进行比较，例如在急性静脉血栓栓塞患者中与皮下注射LMWH、持续静脉注射UFH进行比较。
两位综述作者独立提取数据并评估试验质量。
纳入了15项随机对照试验，共有3054名参与者（干预组1475例患者，对照组1579例患者）。所有主要结局的结果在统计学上均无显著差异。在三个月的随访期间，复发性深静脉血栓形成（DVT）或肺栓塞（PE）的比值比（OR）分别为1.68（95%置信区间（CI）0.92至3.04）和1.18（95%CI 0.54至2.56），支持对照组。肝素治疗期间发生PE的比值比也支持对照组（OR 1.10，95%CI 0.46至2.62）。肝素治疗期间及整个三个月随访期间大出血的OR值无显著差异（分别为1.07，95%CI 0.64至1.79和0.66，95%CI 0.33至1.32）。研究组之间在肝素治疗期间以及三个月随访时与疾病或治疗相关的死亡以及总死亡率没有差异。
就三个月时复发性DVT和PE而言，皮下注射普通肝素治疗静脉血栓栓塞不能被认为不劣于其他治疗方式，但在大出血和死亡率方面似乎同样安全有效。
