Anti-Xa versus time-guided anticoagulation strategies in extracorporeal membrane oxygenation: a systematic review and meta-analysis.
Anti-Xa versus time-guided anticoagulation strategies in extracorporeal membrane oxygenation: a systematic review and meta-analysis.
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DOI：
10.1177/0267659120952982
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发表时间：
2021-07
期刊：
影响因子：
--
通讯作者：
Karam O
中科院分区：
文献类型：
--
作者：
Willems A;Roeleveld PP;Labarinas S;Cyrus JW;Muszynski JA;Nellis ME;Karam O
目的是比较 ECMO 患者的基于时间的抗凝策略与基于抗 Xa 的抗凝策略。我们利用多个电子数据库进行了系统回顾和荟萃分析，纳入了从研究开始到2019年7月19日的研究。评估了出血、血栓形成和死亡率的比例。纳入了 26 项研究（2,086 名患者）。采用基于抗 Xa 的抗凝策略的患者中有 34.2% (95%CI 25.1;43.9) 发生出血，而采用基于时间的抗凝策略的患者中有 41.6% (95%CI 24.9;59.4) 发生出血。采用基于抗 Xa 的抗凝策略的患者中，血栓形成率为 32.6% (95% CI 19.1;47.7)，而采用基于时间的抗凝策略的患者中，血栓形成率为 38.4% (95% CI 22.2;56.1)。采用基于抗 Xa 的抗凝策略患者的死亡率为 35.4% (95% CI 28.9;42.1)，而采用基于时间的抗凝策略的患者死亡率为 42.9% (95% CI 36.9;48.9)。在提供两种抗凝策略结果的七项研究中，基于抗 Xa 的抗凝策略中发生的出血事件显着减少（调整后 OR 0.49 (95%CI 0.32;0.74)，p<0.001），并且死亡率显着降低（调整后 OR 0.61 (95%CI 0.40;0.95)， p = 0.03）。血栓事件没有显着差异（调整后 OR 0.91 (95%CI 0.56;1.49)，p = 0.71）。在这七项观察性研究中，只有一小部分患者是成年人，数据不足以分析 ECMO 类型的效果。在这项对 ECMO 患者观察性研究的荟萃分析中，与基于时间的策略相比，基于抗 Xa 的抗凝策略与较少的出血事件和死亡率相关，并且不会增加血栓事件。
The purpose was to compare time-based vs anti-Xa-based anticoagulation strategies in patients on ECMO. We conducted a systematic review and meta-analysis using multiple electronic databases and included studies from inception to July 19, 2019. The proportion of bleeding, thrombosis, and mortality were evaluated. Twenty-six studies (2,086 patients) were included. Bleeding occurred in 34.2% (95%CI 25.1;43.9) of the patients with anti-Xa-based versus 41.6% (95%CI 24.9;59.4) of the patients with time-based anticoagulation strategies. Thrombosis occurred in 32.6% (95%CI 19.1;47.7) of the patients with anti-Xa-based versus 38.4% (95%CI 22.2;56.1) of the patients with time-based anticoagulation strategies. And mortality rate was 35.4% (95%CI 28.9;42.1) of the patients with anti-Xa-based versus 42.9% (95%CI 36.9;48.9) of the patients with time-based anticoagulation strategies. Among the seven studies providing results from both anticoagulation strategies, significantly fewer bleeding events occurred in the anti-Xa-based anticoagulation strategy (adjusted OR 0.49 (95%CI 0.32;0.74), p < 0.001) and a significantly lower mortality rate (adjusted OR 0.61 (95%CI 0.40;0.95), p = 0.03). There was no significant difference in thrombotic events (adjusted OR 0.91 (95%CI 0.56;1.49), p = 0.71). In these seven observational studies, only a small fraction of the patients were adults, and data were insufficient to analyze the effect of the type of ECMO. In this meta-analysis of observational studies of patients on ECMO, an anti-Xa-based anticoagulation strategy, when compared to a time-based strategy, was associated with fewer bleeding events and mortality rate, without an increase in thrombotic events.
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