Zhou Yifu, Wang Gang, Xue Chunxiao, He Guojun, Zhang Yan, He Feilong, He Chenjun, Liang Xiaosong
Department of Neurosurgery, Affiliated Hospital of Shaoxing University, Shaoxing, China.
Department of Neurosurgery, Affiliated Hospital of Shaoxing University, No. 999, South Zhongxing Road, Shaoxing, Zhejiang 312000, China.
Ther Adv Drug Saf. 2024 May 22;15:20420986241253469. doi: 10.1177/20420986241253469. eCollection 2024.
Venous thromboembolism (VTE) has a serious impact on the prognosis of patients with spontaneous intracranial hemorrhage (sICH). However, the use of prophylactic heparin remains controversial.
This study investigated the safety and timing of prophylactic heparin for VTE in patients with sICH.
This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines.
Two authors systematically searched Web of Science, Cochrane Library, Embase, and PubMed to find all published research before June 2023. The incidence of deep venous thrombosis (DVT) and mortality were set as primary endpoints.
This meta-analysis included seven randomized controlled trials (RCTs) and five observational studies involving a total of 4419 sICH patients in the heparin ( = 2808) and control ( = 1183) groups. Among these patients, 205 received early heparin administration, while 223 received late heparin administration. The results suggested that, compared to the control group, patients in the heparin group had a lower incidence of VTE [odds ratio (OR), 0.47; 95% CI, 0.31-0.71; < 0.001], DVT (OR, 0.53; 95% CI, 0.33-0.85; = 0.009), pulmonary embolism (OR, 0.31 95% CI, 0.15-0.65; = 0.002), and mortality (OR, 0.70; 95% CI, 0.54-0.90; = 0.006), but there were no statistical differences in hematoma enlargement, extracranial hematoma, and major disability ( > 0.05). There was no statistically significant difference in DVT, mortality, hematoma enlargement, and extracranial hemorrhage between the early heparin group (<24-48 h) and the late heparin group ( > 0.05).
In patients with sICH, prophylactic use of heparin may be beneficial because it reduces the incidence of VTE and mortality without increasing the risk of additional bleeding. In addition, early prophylactic use of heparin appears to be safe. However, large-scale RCTs are lacking to support this evidence.
静脉血栓栓塞症（VTE）对自发性颅内出血（sICH）患者的预后有严重影响。然而，预防性使用肝素仍存在争议。
本研究探讨sICH患者预防性使用肝素预防VTE的安全性和时机。
本研究遵循系统评价和Meta分析的首选报告项目（PRISMA）报告指南。
两位作者系统检索了Web of Science、Cochrane图书馆、Embase和PubMed，以查找2023年6月之前发表的所有研究。将深静脉血栓形成（DVT）的发生率和死亡率设定为主要终点。
本Meta分析纳入了7项随机对照试验（RCT）和5项观察性研究，共涉及肝素组（n = 2808）和对照组（n = 1183）的4419例sICH患者。在这些患者中，205例接受早期肝素治疗，223例接受晚期肝素治疗。结果表明，与对照组相比，肝素组患者的VTE发生率[比值比（OR），0.47；95%可信区间（CI），0.31 - 0.71；P < 0.001]、DVT（OR，0.53；95% CI，0.33 - 0.85；P = 0.009）、肺栓塞（OR，0.31；95% CI，0.15 - 0.65；P = 0.002）和死亡率（OR，0.70；95% CI，0.54 - 0.90；P = 0.006）较低，但血肿扩大、颅外血肿和严重残疾方面无统计学差异（P > 0.05）。早期肝素组（<24 - 48小时）和晚期肝素组在DVT、死亡率、血肿扩大和颅外出血方面无统计学显著差异（P > 0.05）。
在sICH患者中，预防性使用肝素可能有益，因为它可降低VTE发生率和死亡率，且不增加额外出血风险。此外，早期预防性使用肝素似乎是安全的。然而，缺乏大规模RCT来支持这一证据。
