Halkin H, Goldberg J, Modan M, Modan B
Ann Intern Med. 1982 May;96(5):561-5. doi: 10.7326/0003-4819-96-5-561.
The effect of prophylactic low-dose heparin on mortality was tested in 1358 consecutive patients admitted to the medical wards of an acute care hospital. Eligibility for treatment or exclusion was ascertained on admission by predefined contraindications. Eligible patients with even-number hospital records were assigned to treatment (5000 U twice daily), those with odd-number records served as controls. Because determination of eligibility was open to bias, evaluation of treatment was based on comparison of the total even-number group (669 patients, of which 411 were treated with heparin), and the total odd-number group (689 patients, none treated with heparin). Mortality was significantly lower in the even-number group-7.8% (52 of 669 patients) versus 10.9% (75 of 689 patients) in the odd-number group; the difference increased consistently with length of hospitalization (p = 0.025). The estimated reduction in mortality attributable to heparin was 31.1%. We believe that low-dose heparin prophylaxis is appropriate in all immobilized medical patients who are not at risk of bleeding.
在一家急症医院内科病房收治的1358例连续患者中，测试了预防性小剂量肝素对死亡率的影响。入院时根据预先确定的禁忌证确定治疗或排除的资格。医院记录为偶数的合格患者被分配接受治疗（每日两次，每次5000单位），记录为奇数的患者作为对照。由于资格确定容易产生偏差，因此治疗评估基于总偶数组（669例患者，其中411例接受肝素治疗）和总奇数组（689例患者，均未接受肝素治疗）的比较。偶数组的死亡率显著较低——7.8%（669例患者中的52例），而奇数组为10.9%（689例患者中的75例）；该差异随住院时间持续增加（p = 0.025）。估计肝素导致的死亡率降低为31.1%。我们认为，对于所有无出血风险的卧床内科患者，预防性使用小剂量肝素是合适的。
