低分子肝素预防围产期静脉血栓栓塞症的疗效：一项荟萃分析。
Efficacy of Low Molecular Weight Heparin in Preventing Perinatal Venous Thrombosis: A Meta-Analysis.
机构信息
Department of Obstetrics, Hainan Women and Children's Medical Center, Haikou 570216, China.
Department of Obstetrics and Gynecology, Chengmai County People's Hospital, Chengmai 571900, China.
出版信息
Comput Math Methods Med. 2022 Jul 26;2022:1248577. doi: 10.1155/2022/1248577. eCollection 2022.
BACKGROUND
There have been controversies about the preventive effect of low molecular weight heparin (LMWH) on venous thrombosis (VT) in the perinatal period. This study is aimed at exploring the effectiveness of LMWH in preventing perinatal VT through meta-analysis.
METHODS
Databases such as CNKI, China Biology Medicine disc (CBMdisc), Wanfang, PubMed, MEDLINE, Embase, and Central were searched. Inclusion criteria were as follows: (1) subjects: women at high risk of perinatal VT; (2) experimental group and control group; (3) intervention measures: the experimental group was given LMWH, while the control group was given placebo or standard heparin or physical therapy; (4) outcomes: perinatal VT events or bleeding events; and (5) randomized controlled trials (RCTs). Jadad scale was used to evaluate the literature quality. The Mantel-Haenszel method was used to calculate the odds ratio (OR) and 95% confidence interval (CI). The chi-square test was used to analyze the heterogeneity of the included literature. Subgroup analysis was used to explore the source of heterogeneity. Publication bias was evaluated via funnel plot and Egger test.
RESULTS
The incidence of perinatal VT in the LMWH group was lower than that in the control group (OR = 0.16, 95% CI (0.08, 0.32), < 0.00001). There was no heterogeneity among literatures ( = 0.77, = 0%) and no publication bias. The incidence of postpartum VT in the LMWH group was lower than that in the control group (OR = 0.14, 95% CI (0.07, 0.30), < 0.00001). There was no heterogeneity among literatures ( = 0.69, = 0%) and no publication bias. The incidence of perinatal bleeding in the LMWH group was higher than in the control group (OR = 1.72, 95% CI (1.06, 2.77), = 0.03). There was no heterogeneity among literatures ( = 0.25, = 26%) and no publication bias.
CONCLUSION
LMWH can reduce the incidence of perinatal VT in high-risk women but increase the risk of bleeding. The use of LMWH to prevent perinatal VT should be closely monitored.
背景
低分子肝素（LMWH）在围产期预防静脉血栓形成（VT）的效果存在争议。本研究旨在通过荟萃分析探讨 LMWH 预防围产期 VT 的效果。
方法
检索中国知网（CNKI）、中国生物医学文献数据库（CBMdisc）、万方、PubMed、MEDLINE、Embase 和中国临床试验注册中心等数据库。纳入标准为：（1）对象：围产期 VT 高危女性；（2）实验组和对照组；（3）干预措施：实验组给予 LMWH，对照组给予安慰剂或标准肝素或物理治疗；（4）结局：围产期 VT 事件或出血事件；（5）随机对照试验（RCT）。采用 Jadad 量表评价文献质量，Mantel-Haenszel 法计算比值比（OR）及其 95%置信区间（CI），采用 检验分析纳入文献的异质性，采用亚组分析探索异质性来源，采用漏斗图和 Egger 检验评估发表偏倚。
结果
LMWH 组围产期 VT 发生率低于对照组（OR = 0.16，95% CI（0.08，0.32），<0.00001）。文献无异质性（ = 0.77， = 0%），无发表偏倚。LMWH 组产后 VT 发生率低于对照组（OR = 0.14，95% CI（0.07，0.30），<0.00001）。文献无异质性（ = 0.69， = 0%），无发表偏倚。LMWH 组围产期出血发生率高于对照组（OR = 1.72，95% CI（1.06，2.77）， = 0.03）。文献无异质性（ = 0.25， = 26%），无发表偏倚。
结论
LMWH 可降低高危女性围产期 VT 发生率，但增加出血风险。使用 LMWH 预防围产期 VT 应密切监测。
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