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首页> 外文期刊>Internal medicine journal >Heparin-based treatment to prevent symptomatic deep venous thrombosis, pulmonary embolism or death in general medical inpatients is not supported by best evidence
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Heparin-based treatment to prevent symptomatic deep venous thrombosis, pulmonary embolism or death in general medical inpatients is not supported by best evidence

机译：最佳证据不支持以肝素为基础的治疗，以防止一般医疗住院患者出现症状性深静脉血栓形成，肺栓塞或死亡

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Prevention of venous thromboembolism (VTE) in medical patients is controversial. In contrast to surgical patients, the evidence supporting the use of heparin-based treatment for prevention of VTE (HVTEp) may not justify current guidelines. This study aims to determine whether current clinical guidelines for HVTEp are appropriate for medical patients. We searched medical databases for original randomised placebo-controlled studies of HVTEp in medical patients, excluding those with stroke and in intensive care. From 401 potentially relevant studies, we selected eight, which included over 16000 patients. HVTEp decreased the incidence of all deep venous thromboses (DVT): 4.3% in the placebo group versus 2.3% in the treatment group, P = 0.002, number needed to treat, 50. However, this treatment effect was not seen for symptomatic DVT: 1.2% versus 0.9%, P = 0.18, odds ratio (OR) 0.72 (0.45-1.16). Similarly, HVTEp did not decrease the incidence of pulmonary embolism (PE): 0.54% versus 0.27%, P = 0.3, OR 0.57 (0.21-1.53), or fatal PE: 0.1% versus 0.0%, P = 0.3, OR 0.2 (0.01-4.11). Furthermore, HVTEp did not decrease total mortality: 5.63% versus 5.39%, P = 0.92, OR 0.96 (0.78-1.18). The use of HVTEp in hospitalised general medical patients does not result in a significant reduction in symptomatic DVT, PE, fatal PE or total mortality. The best evidence does not support the recommendations of the current clinical guidelines.
机译：在医学患者中预防静脉血栓栓塞（VTE）是有争议的。与外科手术患者相反，支持使用基于肝素的疗法预防VTE（HVTEp）的证据可能无法证明当前指南的合理性。这项研究旨在确定当前的HVTEp临床指南是否适合医学患者。我们在医学数据库中搜索了针对中风患者和重症监护患者的HVTEp的原始随机安慰剂对照研究。从401项可能相关的研究中，我们选择了8项，其中包括16000多名患者。 HVTEp降低了所有深静脉血栓形成（DVT）的发生率：安慰剂组为4.3％，治疗组为2.3％，P = 0.002，需要治疗的数量为50。但是，有症状DVT的治疗效果未见： 1.2％和0.9％，P = 0.18，优势比（OR）0.72（0.45-1.16）。同样，HVTEp不会降低肺栓塞（PE）的发生率：0.54％对0.27％，P = 0.3，OR 0.57（0.21-1.53​​），或致命PE：0.1％对0.0％，P = 0.3，OR 0.2（ 0.01-4.11）。此外，HVTEp并未降低总死亡率：5.63％对5.39％，P = 0.92或0.96（0.78-1.18）。在住院的普通内科患者中使用HVTEp不会导致症状性DVT，PE，致命性PE或总死亡率的显着降低。最好的证据不支持当前临床指南的建议。

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