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经皮冠状动脉介入治疗期间低分子量肝素和普通肝素的应用

Administration of low molecular weight and unfractionated heparin during percutaneous coronary intervention.

作者信息

Ali-Hassan-Sayegh Sadegh, Mirhosseini Seyed Jalil, Shahidzadeh Azadeh, Mahdavi Parisa, Tahernejad Mahbube, Haddad Fatemeh, Lotfaliani Mohammad Reza, Sabashnikov Anton, Popov Aron-Frederik

机构信息

Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

出版信息

Indian Heart J. 2016 Mar-Apr;68(2):213-24. doi: 10.1016/j.ihj.2016.01.014. Epub 2016 Jan 26.

Abstract

This systematic review with meta-analysis sought to determine the efficacy and safety of unfractionated heparin (UFH) and low molecular weight heparin (LMWH) on clinical outcomes following percutaneous coronary intervention. Medline, Embase, Elsevier, and web of knowledge as well as Google scholar literature were used for selecting appropriate studies with randomized controlled design. After screening 445 studies, a total of 23 trials (including a total of 43,912 patients) were identified that reported outcomes. Pooled analysis revealed that LMWH compared to UFH could significantly increase thrombolysis in myocardial infarction grade 3 flow (p<0.001), which was associated with similar target vessel revascularization (p=0.6), similar incidence of stroke (p=0.7), and significantly lower incidence of re-myocardial infarction (p<0.001), major bleeding (p=0.02) and mortality (p<0.001). Overall, LMWH was shown to be a useful type of heparin for patients with MI undergoing PCI, due to its higher efficacy and lower rate of complication compared to UFH. It is also associated with increased myocardial perfusion, decreased major hemorrhage, and mortality.

摘要

这项荟萃分析的系统评价旨在确定普通肝素(UFH)和低分子肝素(LMWH)对经皮冠状动脉介入治疗后临床结局的疗效和安全性。使用Medline、Embase、爱思唯尔和科学网以及谷歌学术文献来选择具有随机对照设计的合适研究。在筛选了445项研究后,共确定了23项试验(包括总共43912名患者)报告了结局。汇总分析显示,与UFH相比,LMWH可显著增加心肌梗死溶栓3级血流(p<0.001),这与相似的靶血管血运重建(p=0.6)、相似的卒中发生率(p=0.7)以及显著更低的再发心肌梗死发生率(p<0.001)、大出血发生率(p=0.02)和死亡率(p<0.001)相关。总体而言,与UFH相比,LMWH因其更高的疗效和更低的并发症发生率,被证明是一种对接受PCI的心肌梗死患者有用的肝素类型。它还与心肌灌注增加、大出血减少和死亡率降低相关。

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