抗凝治疗预防脑出血后静脉血栓栓塞的Meta分析

Meta analysis to evaluate the anticoagulant treatment after cerebral hemorrhage of venous thromboembolism prevention

目的探讨抗凝治疗预防脑出血后静脉血栓栓塞的效果和安全性。方法收集计算机检索数据库MEDLINE、PubMed、CochraneRCT、Embase、Biosis中1966年至2010年关于预防脑出血患者深静脉血栓形成抗凝治疗的研究并进行筛选，共纳入随机对照实验（RCT）5篇及病例对照研究2篇。对两者进行Meta分析。结果5项RCT研究的异质性较小（12=0％，P〉0．05），与对照组相比，抗凝药物对深静脉血栓形成有预防效果，但差异无统计学意义（RR=0．68，z=1．66，P〉0．05）；2项病例对照研究显示研究组6例深静脉血栓形成患者中有2例在停用肝素后出现并发症，因此不能充分体现抗凝药物的预防作用；5项RCT研究存在异质性（I2=58％，P=0．05），抗凝组与对照组在颅内血肿扩大或再出血方面差异无统计学意义（P〉0．05）。结论抗凝药物在预防深静脉血栓方面可能有效果，安全性目前缺乏令人信服的证据，故建议对于脑出血患者的深静脉血栓预防，临床上应谨慎使用抗凝药物，尽量个体化治疗。

Objective To evaluate the anticoagulant treatment after intra-cerebral hemorrhage of venous thromboembolism preventive effect and the safety. Methods Collecting the prevention of deep vein thrombosis anticoagulant therapy research of patients with cerebral hemorrhage in retrieval computer database MEDLINE, PubMed, Cochrane RCT, Embase, Biosis from 1966 years to 2010 years, including randomized controlled trials （RCT） and case control study. Three researchers have completed strict quality evaluation and literature data extraction, and have done Meta analysis in RCT and case control study according with the standard of quality. Results We absorbed 5 article of RCT and 2 article of case control study. Five randomized controlled studies have litter heterogeneity （ I2 = 0%, P 〉 0. 05 ） and show that compared with the control, anticoagulation drugs to deep vein thrombosis have preventive effect, but the difference was no statistically significant （ RR = 0. 68, Z = 1.66, P 〉 0. 05 ） ; Two case control study results can＇ t fully embody the anticoagulant utilized prevention function. Research results show that anticoagulation group and control group in intraeranial hematoma enlargement or bleed again have no statistically significant differences. Conclusions Antieoagulation drugs in deep vein thrombosis prevention may have the effect, but the safety is lack of compelling evidence in current. So it was recommended for patients with cerebral hemorrhage of deep vein thrombosis, should be careful to use preventing anticoagulant in clinical, and utilized as far as possible target therapies.