急性冠脉综合征应用磺达肝素钠与低分子肝素出血风险比较的meta分析

Fondaparinux vs. low molecular weight heparin in bleeding risk of acute coronary syndrome: meta-analysis of prospective studies

目的:系统评价磺达肝素钠应用于急性冠脉综合征(acute coronary syndrome,ACS)的安全性。方法:通过全面检索国内外关于低分子肝素(low molecular weight heparin,LMWH)和磺达肝素钠治疗ACS的随机对照研究文献,筛选出符合评价标准的文献,采用RevMan5.1软件进行meta分析,采用Stata 12.0 Egger线性回归法评估纳入文献的发表偏倚。结果:磺达肝素钠组应用于ACS的主要出血事件(RR=0.53,95%CI:0.45-0.61;Z=8.10,P<0.01)、小出血事件(RR=0.33;95%CI:0.27-0.41;Z=10.30;P<0.01)以及总体出血事件(RR=0.44,95%CI:0.39-0.50;Z=13.03,P<0.01)的发生率均低于LMWH组,差别有统计学意义。结论:ACS应用磺达肝素钠较LMWH安全。

AIM： To compare the safety between fondaparinux and low molecular weight heparin （LMWH） in patients with acute coronary syndrome （ACS）, excluding ST-segment elevation myocardial infarction （STEMI）. METHODS： The authors applied the techniques of meta-analysis to data extracted from the published literature addressing this relation. RESULTS： Five trials with a total of 20680 patients were included. Compared with LMWH, fondaparinux was associated with reduced major bleeding （risk ratio [RR] =0.53;95% CI：0.45 to 0.61; Z=8.10; P〈0.01）, minor bleeding （RR=0.33, 95% CI：0.27 to 0.41; Z=10.30, P〈0.01） and total bleeding （RR=0.44, 95% CI： 0.39 to 0.50; Z= 13.03, P 〈0.01）. CONCLUSION： Fondaparinux is safer than low molecular weight heparin in anticoagulant treatment of ACS.