比伐卢定在体外膜氧合抗凝中的有效性和安全性的Meta分析

目的评价比伐卢定在体外膜氧合(ECMO)抗凝中的有效性和安全性。方法计算机检索CNKI、PubMed等数据库在2020年9月之前公开发表的相关文献,并对获得文献进行严格的筛选和质量评价,提取相关数据,采用Rev Man 5.3软件进行统计分析。结果纳入九个研究,共计551人,其中比伐卢定组215人,肝素组336人。Meta分析结果显示:与肝素相比,比伐卢定不能降低病死率(RR=1.01,95%CI:0.78~1.2,P=0.96),不能减少ECMO辅助时间(MD=-12.07,95%CI:-48.57~-24.39,P=0.52),但可以减少显著出血事件发生率RR=0.38,95%CI(0.19,0.73),P=0.004],有减少患者血栓形成发生率(RR=0.61,95%CI:0.36~1.02),P=0.06)及ECMO管路干预发生率(RR=0.66,95%CI:0.42~1.05,P=0.08)的趋势。结论比伐卢定在降低ECMO患者病死率及ECMO辅助时间方面,但并不优于肝素,在减少显著出血事件发生率方面,效果优于肝素;比伐卢定还可能会减少患者血栓形成和ECMO管路干预事件的发生。

Efficacy and safety of bivalirudin in anticoagulation for extracorporeal membrane oxygenation:a meta-analysis

Objective To evaluate the efficacy and safety of bivalirudin in anticoagulation for extracorporeal membrane oxygenation(ECMO).Methods Relevant studies published in CNKI,PubMed and other databases from inception up to September 2020 were systematically searched.Two reviewers strictly screened studies,extracted data,and assesed the methodological quality.Then,meta-analysis was performed by using RevMan 5.3 software.Results A total of 551 patients were involved in 9 studies,including 215 patients in the bivalirudin group and 336 patients in the heparin group.Compared with the heparin group,bivalirudin could not reduce the mortality of ECMO patientsrelative risk(RR)=1.01,95%confidence interval(95%CI)(0.78,1.2),P=0.96]or the duration of ECMOmean difference(MD)=-12.07,95%CI(-48.57,-24.93),P=0.52],but could reduce the incidence of major bleedingRR=0.38,95%CI(0.19,0.73),P=0.004].The incidence of thrombosisRR=0.61,95%CI(0.36,1.02,P=0.06]and the incidence of ECMO circuit interventionsRR=0.66,95%CI(0.42,1.05,P=0.08]showed a decreasing tendency in bivalirudin group.Conclusion Bivalirudin is no better than heparin in reducing the duration of ECMO and the mortality,while it is better than heparin at reducing the incidence of major bleeding events.In addition,the use of bivalirudin in anticoagulation might also reduce the incidence of thrombosis and ECMO circuit interventions.