Li Xinyu, Liu Zhengxiong, Luo Menghua, Xi Yonglin, Li Cheng, Wang Shuixian, Yang Rong
Department of Critical Medicine, the Second Affiliated Hospital of Xi'an Medical University, Xi'an, China.
Ann Palliat Med. 2021 Mar;10(3):3115-3127. doi: 10.21037/apm-21-169.
Low-molecular-weight heparin (LMWH) is a part of standard supportive therapy for sepsis, but clinical research on anticoagulant therapy is still controversial. The aim of the present study was to explore the efficacy and safety of LMWH in adult septic patients by meta-analysis.
Information on randomized controlled trials was retrieved from PubMed, Embase, Web of Science, China National Knowledge Infrastructure, and China Wanfang Database from the establishment of each database to February 20, 2020. The therapeutic efficacy indexes of LMWH for adult septic patients were analyzed by Stata15.0 software.
A total of 684 septic patients were included in 10 trials. The results showed that, compared with conventional treatment, LMWH significantly reduced prothrombin time [mean difference (MD) =-0.48, 95% confidence interval (CI): -0.83 to -0.13], Acute Physiology And Chronic Health Evaluation II score (MD=-4.42, 95% CI: -5.50 to -3.33), and 28-day mortality [relative risk (RR) =0.52, 95% CI: 0.38-0.70], and increased platelet count (MD =34.99, 95% CI: 23.37-46.60). LMWH significantly reduced levels of tumor necrosis factor-α, interleukin-6, and D-dimer, and the incidence of multiple organ dysfunction syndrome (MODS), with statistically significant differences. In addition, LMWH did not increase bleeding events (RR =1.29, 95% CI: 0.76-2.17).
On the basis of routine treatment, LMWH can improve coagulation function, reduce inflammatory reaction and the risk of bleeding, reduce the incidence of MODS and 28-day mortality rate, and improve the prognosis of adult patients with sepsis.
低分子量肝素（LMWH）是脓毒症标准支持治疗的一部分，但抗凝治疗的临床研究仍存在争议。本研究的目的是通过荟萃分析探讨LMWH在成年脓毒症患者中的疗效和安全性。
从PubMed、Embase、Web of Science、中国知网和中国万方数据库中检索从各数据库建立至2020年2月20日的随机对照试验信息。采用Stata15.0软件分析LMWH对成年脓毒症患者的治疗效果指标。
10项试验共纳入684例脓毒症患者。结果显示，与传统治疗相比，LMWH显著缩短凝血酶原时间[平均差（MD）=-0.48，95%置信区间（CI）：-0.83至-0.13]、急性生理与慢性健康状况评分系统II评分（MD=-4.42，95%CI：-5.50至-3.33）以及28天死亡率[相对危险度（RR）=0.52，95%CI：0.38 - 0.70]，并增加血小板计数（MD =34.99，95%CI：23.37至46.60）。LMWH显著降低肿瘤坏死因子-α、白细胞介素-6和D-二聚体水平以及多器官功能障碍综合征（MODS）的发生率，差异有统计学意义。此外，LMWH未增加出血事件（RR =1.29，95%CI：0.76至2.17）。
在常规治疗的基础上，LMWH可改善凝血功能，降低炎症反应和出血风险，降低MODS发生率和28天死亡率，改善成年脓毒症患者的预后。
