Institute of Clinical Medicine, University of Oslo, Oslo, Norway,
Intensive Care Med. 2015 Jul;41(7):1209-19. doi: 10.1007/s00134-015-3840-z. Epub 2015 May 14.
To compare benefits and harms of low molecular weight heparin (LMWH) versus unfractionated heparin (UFH) as thromboprophylaxis in intensive care unit (ICU) patients.
We conducted a systematic review with meta-analysis and trial sequential analysis (TSA) of randomised controlled trials (RCTs) comparing LMWH with UFH as thromboprophylaxis in adult ICU patients. We searched Ovid Medline, PubMed, Embase, Cochrane Library, UpToDate, Guidelines International Network, PROSPERO and the metaRegister of Controlled Trials through 3 December 2014. Random effects risk ratios (RR) and 95% confidence intervals (CI) were derived for the endpoints deep vein thrombosis (DVT), pulmonary embolism (PE), major bleeding, mortality and net clinical benefit (any DVT, any PE, major bleeding and/or mortality).
Eight RCTs (5567 patients) were included, whereof two were considered to have overall low risk of bias. Pooled analyses showed that LMWH compared with UFH reduced the risk of any DVT (RR 0.84, 95% CI 0.71-0.98, p = 0.03) and resulted in a net clinical benefit (RR 0.90, 95% CI 0.83-0.97, p = 0.01). There was no statistically significant difference in the risk of any PE (RR 0.65, 95% CI 0.41-1.03, p = 0.06), major bleeding (RR 0.99, 95% CI 0.77-1.28, p = 0.96) or mortality (RR 0.93, 95% CI 0.78-1.12, p = 0.43). TSA supported the results of the conventional analysis on the outcome net clinical benefit but not on risk of any DVT.
Evidence from this systematic review revealed a beneficial effect of LMWH compared with UFH when used as thromboprophylaxis in ICU patients.
比较低分子肝素（LMWH）与未分级肝素（UFH）作为重症监护病房（ICU）患者血栓预防的益处和危害。
我们对比较 LMWH 与 UFH 作为 ICU 成年患者血栓预防的随机对照试验（RCT）进行了系统评价和荟萃分析及试验序贯分析（TSA）。我们通过 12 月 3 日检索了 Ovid Medline、PubMed、Embase、Cochrane 图书馆、UpToDate、指南国际网络、PROSPERO 和对照试验注册中心，纳入了 RCTs。对终点深静脉血栓形成（DVT）、肺栓塞（PE）、大出血、死亡率和净临床获益（任何 DVT、任何 PE、大出血和/或死亡率）进行了风险比（RR）和 95%置信区间（CI）的随机效应分析。
共纳入了 8 项 RCTs（5567 例患者），其中两项被认为整体偏倚风险低。汇总分析显示，与 UFH 相比，LMWH 降低了任何 DVT 的风险（RR 0.84，95% CI 0.71-0.98，p = 0.03），并带来了净临床获益（RR 0.90，95% CI 0.83-0.97，p = 0.01）。在任何 PE 的风险（RR 0.65，95% CI 0.41-1.03，p = 0.06）、大出血（RR 0.99，95% CI 0.77-1.28，p = 0.96）或死亡率（RR 0.93，95% CI 0.78-1.12，p = 0.43）方面，两组间没有统计学差异。TSA 支持常规分析在净临床获益方面的结果，但不支持任何 DVT 风险方面的结果。
本系统评价的证据表明，LMWH 与 UFH 相比，在 ICU 患者中作为血栓预防使用时具有有益的效果。
