Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road. 1277#, Wuhan, 430022, Hubei, P. R. China.
The Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
J Orthop Surg Res. 2021 Apr 14;16(1):262. doi: 10.1186/s13018-021-02412-7.
Unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are commonly used for preventing venous thrombosis of the lower extremity in patients with traumatic spinal cord injury. Although, LMWH is the most commonly used drug, it has yet to be established whether it is more effective and safer than UFH. Further, a comparison of the effectiveness of LMWH in preventing thrombosis at different locations and different degrees of spinal cord injury has also not been clearly defined.
Cohort studies comparing the use of LMWH and UFH in the prevention of lower limb venous thrombosis in patients with spinal cord injury were identified using PubMed. The risk of bias and clinical relevance of the included studies were assessed using forest plots. The Newcastle-Ottawa quality assessment scale was used to evaluate the quality of the included studies. The main results of the study were analyzed using Review Manager 5.3.
A total of five studies were included in this meta-analysis. Four studies compared the effectiveness and safety of LMWH and UFH in preventing thrombosis in patients with spinal cord injury. No significant differences were found between the therapeutic effects of the two drugs, and the summary RR was 1.33 (95% CI 0.42-4.16; P = 0.63). There was also no significant difference in the risk of bleeding between the two medications, and the aggregate RR was 0.78 (95% CI 0.55-1.12; P = 0.18). When comparing the efficacy of LMWH in preventing thrombosis in different segments and different degrees of spinal cord injury, no significant differences were found.
The results of this analysis show that compared with UFH, LMWH has no obvious advantages in efficacy nor risk prevention, and there is no evident difference in the prevention of thrombosis for patients with injuries at different spinal cord segments.
普通肝素（UFH）和低分子肝素（LMWH）常用于预防创伤性脊髓损伤患者下肢静脉血栓形成。尽管 LMWH 是最常用的药物，但尚未确定其是否比 UFH 更有效和更安全。此外，LMWH 在预防不同部位和不同程度脊髓损伤的血栓形成方面的有效性比较也尚未明确界定。
通过 PubMed 确定了比较 LMWH 和 UFH 在预防脊髓损伤患者下肢静脉血栓形成中的应用的队列研究。使用森林图评估纳入研究的偏倚风险和临床相关性。使用纽卡斯尔-渥太华质量评估量表评估纳入研究的质量。使用 Review Manager 5.3 分析研究的主要结果。
共有五项研究纳入本荟萃分析。四项研究比较了 LMWH 和 UFH 在预防脊髓损伤患者血栓形成方面的有效性和安全性。两种药物的治疗效果无显著差异，汇总 RR 为 1.33（95%CI 0.42-4.16；P = 0.63）。两种药物的出血风险也无显著差异，汇总 RR 为 0.78（95%CI 0.55-1.12；P = 0.18）。比较 LMWH 在预防不同脊髓节段和不同程度脊髓损伤患者血栓形成的疗效时，也未发现显著差异。
本分析结果表明，与 UFH 相比，LMWH 在疗效和预防风险方面没有明显优势，在预防不同脊髓节段损伤患者血栓形成方面也没有明显差异。
