Department of Hematology, Sultan Qaboos University, Sultan Qaboos University Hospital, Oman.
Department of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia.
Thromb Res. 2018 Sep;169:135-139. doi: 10.1016/j.thromres.2018.07.023. Epub 2018 Jul 25.
Anticoagulation with unfractionated heparin (UFH) or low molecular weight heparin (LMWH) is the mainstay for the treatment of patients with acute cerebral vein thrombosis (CVT) with or without intracranial hemorrhage (ICH).
We conducted a systematic review and meta-analysis to determine the efficacy and safety of LMWH compared to UFH for the treatment of acute CVT.
An electronic search of MEDLINE, Pubmed, CENTRAL and Google Scholar was performed. Randomized controlled trials (RCT) reporting on the efficacy and safety of anticoagulation for acute treatment of CVT were included. Outcomes of interest included mortality, disability, new ICH and pulmonary embolism (PE).
Overall, 4 RCTs were included in the meta-analysis. Two trials compared anticoagulation (UFH (N = 1) and LMWH (N = 1)) to placebo. The use of anticoagulation therapy was associated with an odd ratio (OR) for mortality and disability of 0.31 (95% confidence interval (CI) 0.07 to 1.45; p = 0.14) and 0.3 (95% CI 0.09 to 1.01; p = 0.05), respectively. Three new ICHs were observed among patients receiving placebo and no patient had a PE complication. The other two trials compared LMWH to UFH. LMWH was associated with an OR for mortality and disability of 0.21 (95% CI 0.02 to 2.44, p = 0.21) and 0.5 (95% CI 0.11 to 2.23; p = 0.36), respectively. There were no new events of ICH or PE.
LMWH seems to be safe and effective for the management of acute CVT.
对于伴有或不伴有颅内出血（ICH）的急性脑静脉血栓形成（CVT）患者，抗凝治疗采用普通肝素（UFH）或低分子肝素（LMWH）为主。
我们进行了系统评价和荟萃分析，以确定 LMWH 与 UFH 相比治疗急性 CVT 的疗效和安全性。
电子检索 MEDLINE、Pubmed、CENTRAL 和 Google Scholar，纳入报告抗凝治疗急性 CVT 的疗效和安全性的随机对照试验（RCT）。感兴趣的结局包括死亡率、残疾、新 ICH 和肺栓塞（PE）。
总体上，共有 4 项 RCT 纳入荟萃分析。其中两项试验比较了抗凝治疗（UFH（N=1）和 LMWH（N=1））与安慰剂。抗凝治疗组的死亡率和残疾的比值比（OR）分别为 0.31（95%置信区间（CI）0.07 至 1.45；p=0.14）和 0.3（95%CI 0.09 至 1.01；p=0.05）。接受安慰剂的患者中观察到 3 例新 ICH，无患者发生 PE 并发症。另外两项试验比较了 LMWH 与 UFH。LMWH 组的死亡率和残疾的 OR 分别为 0.21（95%CI 0.02 至 2.44，p=0.21）和 0.5（95%CI 0.11 至 2.23；p=0.36）。无新的 ICH 或 PE 事件。
LMWH 似乎安全有效，可用于治疗急性 CVT。
