Comparison of Bivalirudin Versus Heparin for Anticoagulation During Extracorporeal Membrane Oxygenation
Comparison of Bivalirudin Versus Heparin for Anticoagulation During Extracorporeal Membrane Oxygenation
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DOI：
10.1097/mat.0000000000001814
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发表时间：
2023-04-01
期刊：
影响因子：
4.2
通讯作者：
Im Lee, Young
中科院分区：
文献类型：
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作者：
Hasegawa, Daisuke;Sato, Ryota;Im Lee, Young
比伐卢定与肝素在体外膜氧合(ECMO)患者中的疗效和安全性尚不清楚。因此，我们进行了一项系统的回顾和荟萃分析，以比较肝素和比伐卢定在接受ECMO的患者中的有效性和安全性。我们搜索了Embase、Cochrane对照试验中央注册中心和MEDLINE。纳入标准包括(1)接受ECMO的患者和(2)接受比伐卢定或肝素的患者。我们排除了大多数患者在临床过程中将肝素转换为比伐卢定或相反的研究。主要结果是短期死亡率。我们使用随机效应模型展示了所有分析的结果。11项研究报告了短期死亡率。使用比伐卢定与肝素相比，短期死亡率显著降低(优势比：0.71，95%可信区间0.55-0.92；p=0.01，I-2=7%)。在这项观察性研究的荟萃分析中，与肝素相比，比伐卢定的使用与显著降低的短期死亡率相关。进一步的前瞻性研究是有必要澄清这一发现的。
The effect and safety of bivalirudin compared with heparin in patients undergoing extracorporeal membrane oxygenation (ECMO) remains unclear. Therefore, we conducted a systematic review and meta-analysis to compare the effectiveness and safety of heparin and bivalirudin in patients who underwent ECMO. We searched Embase, the Cochrane Central Register of Controlled Trials, and MEDLINE. Inclusion criteria included patients (1) undergoing ECMO and (2) receiving bivalirudin or heparin. We excluded studies where the majority of patients switched heparin to bivalirudin or vice versa during the clinical course. The primary outcome was short-term mortality. We presented the results of all analyses with the use of random-effects models. Eleven studies reported short-term mortality. The use of bivalirudin was associated with significantly lower short-term mortality, compared with heparin (odds ratio: 0.71, 95% confidence interval, 0.55-0.92; p = 0.01, I-2 = 7%). In this meta-analysis of observational studies, the use of bivalirudin was associated with significantly lower short-term mortality, compared with heparin. Further prospective studies are warranted to clarify this finding.