Periprocedural heparin bridging in patients receiving oral anticoagulation: a systematic review and meta-analysis.
Periprocedural heparin bridging in patients receiving oral anticoagulation: a systematic review and meta-analysis.
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接受口服抗凝治疗的患者围手术期肝素桥接：系统评价和荟萃分析
DOI：
10.1186/s12872-017-0719-7
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发表时间：
2017-12-13
影响因子：
2.1
通讯作者：
Wang ZJ
中科院分区：
文献类型：
--
作者：
Yong JW;Yang LX;Ohene BE;Zhou YJ;Wang ZJ
背景围手术期肝素桥接治疗的目的是降低需要中断抗凝治疗的患者发生血栓栓塞事件的风险。肝素桥接治疗的有效性和安全性尚未得到很好的建立。ObjectivesTo comparison through meta-analysis the effects of heparin bridging therapy on the risk of major bleeding and thromboembolic events of clinical significance among patients taking oral anticoagulants.MethodsWe searched PubMed，EMBASE and the科克伦图书馆从2005年1月至2016年7月。如果研究报告了在手术中断口服抗凝剂期间接受肝素桥接治疗的患者的临床结局，则纳入研究。使用随机效应modeling.ResultsA共25项研究，包括6项随机对照试验和19项观察性研究，数据进行汇总，最终纳入本分析。在所有35，944例患者中，10，313例患者被分配为肝素桥接组，其余25，631例患者为非肝素桥接组。总的来说，与未接受桥接治疗的患者相比，肝素桥接治疗增加了大出血的风险（OR = 3.23，95%CI：2.06-5.05），轻微出血（OR = 1.52，95%CI：1.06-2.18）和总体出血（OR = 2.83，95%CI：1.86-4.30），而血栓栓塞事件无显著差异（OR = 0.99，95%CI：0.49-2.00）、中风或短暂性脑缺血发作（OR = 1.45，95%CI：0.93-2.26）或全因死亡率结论与非肝素桥接治疗相比，肝素桥接治疗增加了大出血和小出血的风险，但没有降低血栓栓塞事件和全因死亡的风险。
BackgroundPeriprocedural heparin bridging therapy aims to reduce the risk of thromboembolic events in patients requiring an interruption in their anticoagulation therapy for the purpose of an elective procedure. The efficacy and safety of heparin bridging therapy has not been well established.ObjectivesTo compare through meta-analysis the effects of heparin bridging therapy on the risk of major bleeding and thromboembolic events of clinical significance among patients taking oral anticoagulants.MethodsWe searched PubMed, EMBASE and the Cochrane library from January 2005 to July 2016. Studies were included if they reported clinical outcomes of patients receiving heparin bridging therapy during interruption of oral anticoagulant for operations. Data were pooled using random-effects modeling.ResultsA total of 25 studies, including 6 randomized controlled trials and 19 observational studies, were finally included in this analysis. Among all the 35,944 patients, 10,313 patients were assigned as heparin bridging group, and the other 25,631 patients were non-heparin bridging group. Overall, compared with patients without bridging therapy, heparin bridging therapy increased the risk of major bleeding (OR = 3.23, 95%CI: 2.06–5.05), minor bleeding (OR = 1.52, 95%CI: 1.06–2.18) and overall bleeding (OR = 2.83, 95%CI: 1.86–4.30).While there was no significant difference in thromboembolic events (OR = 0.99,95%CI: 0.49–2.00), stroke or transient ischemic attack(OR = 1.45, 95%CI: 0.93–2.26,) or all-cause mortality (OR = 0.71, 95%CI: 0.31–1.65).ConclusionsHeparin-bridging therapy increased the risk of major and minor bleeding without decreasing the risk of thromboembolic events and all cause death compared to non-heparin bridging.
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影响因子：
6.7
作者：
Douketis, James D.;Healey, Jeff S.;Connolly, Stuart J.
通讯作者：
Connolly, Stuart J.
影响因子：
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作者：
Garcia, David A.;Regan, Susan;Hylek, Elaine M.
通讯作者：
Hylek, Elaine M.
影响因子：
7.5
作者：
Daniels, Paul R.;McBane, Robert D.;Heit, John A.
通讯作者：
Heit, John A.
影响因子：
158.5
作者：
Birnie, David H.;Healey, Jeff S.;Essebag, Vidal
通讯作者：
Essebag, Vidal
影响因子：
4.8
作者：
Tischenko, Alex;Gula, Lorne J.;Kraho, Andrew D.
通讯作者：
Kraho, Andrew D.