Respiratory Diseases Laboratory, Chengdu Second People's Hospital, No. 10, Qingyun South Street, Chengdu, 610017, China.
Department of Pulmonary Diseases, West China Hospital, Sichuan University, Chengdu, China.
Inflammopharmacology. 2020 Apr;28(2):451-462. doi: 10.1007/s10787-019-00659-5. Epub 2019 Oct 31.
Low molecular weight heparin (LMWH) is an anticoagulant that has recently been found benefit in the acute exacerbation stage of chronic obstructive pulmonary disease (COPD). But its efficacy is controversial. The objective of this paper is to compare the harm/benefit of LMWH combined with conventional therapy versus single conventional therapy in the acute exacerbation stage of COPD.
PubMed, Cochrane Library, EMBASE, CNKI, and Clinical Trials.gov were searched from inception until March 2019. Randomized control trials were included if they reported the use of LMWH for the treatment of COPD. Continuous variable data were reported as mean difference (MD), risk difference (RD), and Peto odds ratio (OR) with corresponding 95% CIs.
Twelve RCTs (N = 1086 subjects) were included in the meta-analysis. Pooled results exhibited that LMWH treatment significantly improved the levels of arterial partial pressure of oxygen (PaO) (MD = 4.58, 95% CI: 1.78-7.39, P = 0.001), forced expiratory volume in 1 s (FEV1) (MD = 0.19, 95% CI: 0.09-0.29, P = 0.0002), and FEV1/forced vital capacity (FVC) (MD = 10.44, 95% CI: 5.40-15.48, P < 0.0001), and significantly reduced the risk of thrombosis (RD, - 0.03; 95% CI, - 0.07 to 0.00; P = 0.05). There was a marginally but nonsignificant improvement in PaCO levels vs non-LMWH treatment. Moreover, pooled results exhibited that LMWH may increase the risk of hemorrhage. Subgroup analyses exhibited that LMWH treatment only was associated with a significantly increased risk of minor bleeding but not major hemorrhage.
When compared with single conventional therapy, addition of LMWH to conventional therapy may provide more clinical benefits in the acute exacerbation stage of COPD.
低分子肝素（LMWH）是一种抗凝剂，最近在慢性阻塞性肺疾病（COPD）急性加重期被发现有益。但其疗效存在争议。本文旨在比较 LMWH 联合常规治疗与单纯常规治疗在 COPD 急性加重期的疗效和安全性。
检索PubMed、Cochrane Library、EMBASE、中国知网（CNKI）和临床试验.gov 数据库，从建库至 2019 年 3 月，纳入 LMWH 治疗 COPD 的随机对照试验。连续性变量采用均数差（MD）、风险差（RD）和 Peto 比值比（OR）及其 95%可信区间（CI）表示。
共纳入 12 项 RCT（1086 例患者）。Meta 分析结果显示，LMWH 治疗可显著提高动脉血氧分压（PaO）（MD=4.58，95%CI：1.78-7.39，P=0.001）、用力肺活量（FEV1）（MD=0.19，95%CI：0.09-0.29，P=0.0002）和 FEV1/用力肺活量（FVC）（MD=10.44，95%CI：5.40-15.48，P<0.0001），降低血栓形成风险（RD，-0.03；95%CI，-0.07 至 0.00；P=0.05），但对 PaCO 水平的影响无统计学意义。亚组分析显示，LMWH 治疗仅与轻微出血风险增加显著相关，而与大出血风险无关。
与单纯常规治疗相比，在 COPD 急性加重期，LMWH 联合常规治疗可能带来更多的临床获益。
