Pan Xi, Li Jihui, Xu Lan, Deng Shengming, Wang Zhi
Departments of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
Department of Nuclear Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
J Neurol Surg A Cent Eur Neurosurg. 2020 May;81(3):253-260. doi: 10.1055/s-0039-3400497. Epub 2020 Jan 21.
Patients with spontaneous intracerebral hemorrhage (sICH) have a nearly fourfold greater risk for venous thromboembolism (VTE) than those with acute ischemic stroke, and VTE after sICH is associated with high risk for in-hospital mortality. The benefit from prophylactic heparin for VTE remains uncertain because its safety is not documented. In this study, we used an updated meta-analysis to evaluate the safety of heparin for the prevention of VTE in patients with sICH.
Electronic databases Medline and Embase from January 1990 to November 2017 and the Cochrane Library were searched using these keywords: and We evaluated the quality of included studies according to the bias risk in the Cochrane Handbook for Systematic Reviews of Interventions v.5.1.0. All statistical analyses were performed with RevMan v.5 software (Cochrane Collaboration, London, United Kingdom). Tests of heterogeneity were conducted with the Mantel-Haenszel method.
Nine studies involving 4,055 patients with sICH met the inclusion criteria in this meta-analysis. Of these studies, only one met all specific criteria and had a low probability of bias, whereas eight studies met only some of the criteria and had a moderate probability of bias. In comparison with non-heparin treatments, low-molecular-weight heparin or unfractionated heparin was associated with a nonsignificant increase in any hematoma enlargement, a nonsignificant reduction in extracranial hemorrhage, a nonsignificant increase in mortality, a nonsignificant increase in the number of modified Rankin Scale scores of 3 to 5, and a nonsignificant increase in numbers of Glasgow Outcome Scale scores of 2 to 3.
Prophylactic heparin was associated with a nonsignificant increase in any hematoma enlargement and mortality, a nonsignificant reduction in extracranial hemorrhage, and a nonsignificant increase in the incidence of major disability in patients with sICH. It is probably safe to administer heparin to prevent VTE in patients with sICH.
自发性脑出血（sICH）患者发生静脉血栓栓塞（VTE）的风险比急性缺血性卒中患者高近四倍，且sICH后的VTE与院内死亡高风险相关。预防性使用肝素预防VTE的获益仍不确定，因为其安全性尚无文献记载。在本研究中，我们采用更新的荟萃分析来评估肝素预防sICH患者发生VTE的安全性。
使用关键词检索1990年1月至2017年11月的电子数据库Medline和Embase以及Cochrane图书馆：我们根据《Cochrane干预措施系统评价手册》第5.1.0版中的偏倚风险评估纳入研究的质量。所有统计分析均使用RevMan v.5软件（Cochrane协作网，英国伦敦）进行。采用Mantel-Haenszel方法进行异质性检验。
九项涉及4055例sICH患者的研究符合本荟萃分析的纳入标准。在这些研究中，只有一项符合所有特定标准且偏倚概率较低，而八项研究仅符合部分标准且偏倚概率中等。与非肝素治疗相比，低分子量肝素或普通肝素与任何血肿扩大的非显著性增加、颅外出血的非显著性减少、死亡率的非显著性增加、改良Rankin量表评分3至5分数量的非显著性增加以及格拉斯哥预后量表评分2至3分数量的非显著性增加相关。
预防性使用肝素与sICH患者任何血肿扩大和死亡率的非显著性增加、颅外出血的非显著性减少以及严重残疾发生率的非显著性增加相关。对sICH患者使用肝素预防VTE可能是安全的。
