磺达肝素预防术后肺血栓栓塞的荟萃分析

目的:评估磺达肝素对术后发生肺血栓栓塞(PTE)的预防作用,并系统分析磺达肝素和一般低分子肝素(LMWH)疗效和安全性的差异。方法:从Medline、Cochrane图书馆和中国生物医学文献数据库(CBM)检索公开发表的文章(2000年1月—2007年6月),以磺达肝素或LMWH类药物(对照)预防术后PTE的随机对照试验(RCT)为研究对象,采用Rev Man 4.2软件进行统计分析。结果:对符合纳入标准的5篇文献共10 271例病人进行荟萃分析,根据意向性分析(ITT)磺达肝素组和对照组术后PTE发病率分别为0.31%和0.25%,2组比数比(OR)为1.23(95%CI为0.59～2.57),差异无显著意义(P>0.05)。2组术后严重出血发生率分别为2.82%和1.89%,OR值为1.51(95%CI为0.73～1.83),差异有显著意义(P<0.01)。2组术后轻微出血发生率分别为2.73%和2.37%,OR值为1.15(95%CI为0.90～1.48),差异无显著意义(P>0.05)。结论:磺达肝素预防术后PTE的疗效与一般LMWH相当,两者术后轻微出血发生率相似,但磺达肝素引起术后严重出血的危险性相对较高。

Fondaparinux prevention of pulmonary thromboembolism after surgery: a Meta-analysis

AIM:To assess the efficacy and safety of fondaparinux versus low molecular weight heparin (LMWH) for the prevention of pulmonary thromboembolism (PTE) after surgery.METHODS:All the randomized controlled trials (RCT) of‘fondaparinux’or‘LNWH’in prevention of PTE after surgery from Medline,the Cochrane Library,CMB (January 2000 to June 2007) were comprehensively undertaken with furthermore Meta-analysis conducted on combining the odd ratios of the individual studies through Rev Man 4.2 software statistically.RESULTS:Of the 5 standardized articles screened,10 271 cases were included in the Meta-analysis with the occurrence rates of PTE after surgery (intention-to-treat,ITT) in fondaparinux group as 0.31% vs control group 0.25%,the odds ratio (OR) outcoming 1.23 (95 % CI was 0.59-2.57),with no statistical significance (P>0.05).The incidence of major bleeding after surgery of the two groups were 2.82% and 1.89%,respectively,the OR was 1.51 (95% CI was 0.73-1.83),with statistically significant difference (P<0.01).The incidence of minor bleeding after surgery of the two groups were 2.73% and 2.37%,respectively, with OR 1.15 (95% CI was 0.90-1.48),having no statistical significance (P>0.05).CONCLUSION: Fondaparinux is as effective as LMWH in prevention of PTE after surgery,similar the risk of minor bleeding after surgery,but with a high risk of severe bleeding after surgery in comparing with LMWH.