Department of Cardiac and Thoracic Surgery, University Clinic Aachen, RWTH Aachen University Clinic, Pauwelsstraße 30, Aachen, 52074, Germany.
Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy.
Int J Clin Pharm. 2021 Aug;43(4):825-838. doi: 10.1007/s11096-021-01260-z. Epub 2021 Mar 28.
Background Argatroban, lepirudin, desirudin, bivalirudin, and danaparoid are commonly used to manage heparin-induced thrombocytopenia related complications. However, the most suitable drug for this condition still remains controversial. Aim of the review This Bayesian network meta-analysis study compared the most common anticoagulant drugs used in the management of heparin-induced thrombocytopenia. Method All clinical trials comparing two or more anticoagulant therapies for suspected or confirmed heparin-induced thrombocytopenia were considered for inclusion. Studies concerning the use of heparins or oral anticoagulants were not considered. Data concerning hospitalisation length, thromboembolic, major, and minor haemorrhagic events, and mortality rate were collected. The network analyses were made through the STATA routine for Bayesian hierarchical random-effects model analysis with standardised mean difference (SMD) and log odd ratio (LOR) effect measures. Results Data from a total of 4338 patients were analysed. The overall mean age was 62.31 ± 6.6 years old. Hospitalization length was considerably shorter in favour of the argatroban group (SMD: - 1.70). Argatroban evidenced the lowest rate of major (LOR: - 1.51) and minor (LOR: - 0.57) haemorrhagic events. Argatroban demonstrated the lowest rate of thromboembolic events (LOR: 0.62), and mortality rate (LOR: - 1.16). Conclusion Argatroban performed better overall for selected patients with HIT. Argatroban demonstrated the shortest hospitalization, and lowest rate of haemorrhages, thromboembolisms, and mortality compared to bivalirudin, lepirudin, desirudin, and danaparoid.
阿加曲班、来匹卢定、地西卢定、比伐卢定和达那肝素是常用于管理肝素诱导的血小板减少症相关并发症的药物。然而，对于这种情况，最适合的药物仍存在争议。
本贝叶斯网状meta 分析研究比较了肝素诱导的血小板减少症管理中最常用的抗凝药物。
所有比较两种或更多种抗凝治疗疑似或确诊肝素诱导的血小板减少症的临床试验均被纳入研究。不考虑肝素或口服抗凝剂的使用研究。收集有关住院时间、血栓栓塞、主要和次要出血事件以及死亡率的数据。网络分析通过 STATA 常规进行贝叶斯分层随机效应模型分析，采用标准化均数差（SMD）和对数优势比（LOR）效应测量。
共分析了 4338 例患者的数据。总体平均年龄为 62.31±6.6 岁。阿加曲班组的住院时间明显缩短（SMD：-1.70）。阿加曲班的大出血主要事件发生率最低（LOR：-1.51）和次要事件发生率最低（LOR：-0.57）。阿加曲班的血栓栓塞事件发生率最低（LOR：0.62），死亡率最低（LOR：-1.16）。
对于选定的肝素诱导的血小板减少症患者，阿加曲班总体表现更好。与比伐卢定、来匹卢定、地西卢定和达那肝素相比，阿加曲班的住院时间最短，出血、血栓栓塞和死亡率最低。
