Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France.
BMJ. 2012 Feb 3;344:e553. doi: 10.1136/bmj.e553.
To determine the efficacy and safety of enoxaparin compared with unfractionated heparin during percutaneous coronary intervention.
Systematic review and meta-analysis.
Medline and Cochrane database of systematic reviews, January 1996 to May 2011.
Randomised and non-randomised studies comparing enoxaparin with unfractionated heparin during percutaneous coronary intervention and reporting on both mortality (efficacy end point) and major bleeding (safety end point) outcomes.
Sample size, characteristics, and outcomes, extracted independently and analysed.
23 trials representing 30,966 patients were identified, including 10,243 patients (33.1%) undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction, 8750 (28.2%) undergoing secondary percutaneous coronary intervention after fibrinolysis, and 11,973 (38.7%) with non-ST elevation acute coronary syndrome or stable patients scheduled for percutaneous coronary intervention. A total of 13,943 patients (45.0%) received enoxaparin and 17,023 (55.0%) unfractionated heparin. Enoxaparin was associated with significant reductions in death (relative risk 0.66, 95% confidence interval 0.57 to 0.76; P<0.001), the composite of death or myocardial infarction (0.68, 0.57 to 0.81; P<0.001), and complications of myocardial infarction (0.75, 0.6 to 0.85; P<0.001), and a reduction in incidence of major bleeding (0.80, 0.68 to 0.95; P=0.009). In patients who underwent primary percutaneous coronary intervention, the reduction in death (0.52, 0.42 to 0.64; P<0.001) was particularly significant and associated with a reduction in major bleeding (0.72, 0.56 to 0.93; P=0.01).
Enoxaparin seems to be superior to unfractionated heparin in reducing mortality and bleeding outcomes during percutaneous coronary intervention and particularly in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction.
比较依诺肝素与普通肝素在经皮冠状动脉介入治疗中的疗效和安全性。
系统评价和荟萃分析。
Medline 和 Cochrane 系统评价数据库，1996 年 1 月至 2011 年 5 月。
比较依诺肝素与普通肝素在经皮冠状动脉介入治疗中，并报告死亡率（疗效终点）和大出血（安全性终点）结局的随机和非随机研究。
独立提取样本量、特征和结果并进行分析。
共纳入 23 项试验，涉及 30966 例患者，包括 10243 例（33.1%）因 ST 段抬高型心肌梗死行直接经皮冠状动脉介入治疗，8750 例（28.2%）溶栓后行补救性经皮冠状动脉介入治疗，11973 例（38.7%）非 ST 段抬高型急性冠状动脉综合征或稳定型患者拟行经皮冠状动脉介入治疗。共有 13943 例（45.0%）患者接受依诺肝素治疗，17023 例（55.0%）患者接受普通肝素治疗。依诺肝素与死亡率显著降低相关（相对风险 0.66，95%置信区间 0.57 至 0.76；P<0.001），死亡或心肌梗死的复合终点（0.68，0.57 至 0.81；P<0.001）和心肌梗死并发症（0.75，0.60 至 0.85；P<0.001）减少，大出血发生率降低（0.80，0.68 至 0.95；P=0.009）。在接受直接经皮冠状动脉介入治疗的患者中，死亡率降低（0.52，0.42 至 0.64；P<0.001）尤其显著，且与大出血减少相关（0.72，0.56 至 0.93；P=0.01）。
依诺肝素似乎优于普通肝素，可降低经皮冠状动脉介入治疗中的死亡率和出血结局，尤其在 ST 段抬高型心肌梗死患者中。
