低分子肝素治疗进展性卒中疗效与安全性的系统评价

目的对低分子肝素治疗进展性卒中的有效性及安全性进行系统评价。方法检索PubMed、Embase、Cochrane Library、美国临床试验数据库(ClinicalTrials.gov)、中国生物医学文献服务系统(SinoMed)、中国知网、维普、万方数据库等中英文数据库,搜集有关低分子肝素治疗进展性卒中的随机对照试验(RCT),检索时限为建库至2020年6月5日。由2位研究者独立筛选文献、提取资料并评价纳入文献的偏倚风险;采用RevMan 5.3软件进行Meta分析。结果共纳入14个RCT,1225例患者。Meta分析结果显示,与对照组(常规治疗)相比,观察组(常规治疗基础上加用低分子肝素)有效率显著提高(RR=3.69,95%CI:2.66~5.13,P<0.001);且患者神经功能缺损评分(MD=-6.16,95%CI:-7.80^-4.52,P<0.001)和美国国立卫生研究院脑卒中量表评分(MD=-3.09,95%CI:-4.66^-1.51,P=0.001)的改善更显著。观察组患者死亡率降低,且差异有统计学意义(P<0.05);但2组间出血发生率比较,差异无统计学意义(P>0.05)。结论在治疗进展性卒中时,低分子肝素能提高治疗的有效率,改善患者的神经功能评分,死亡率低且不增加出血发生率。但由于受纳入文献数量和质量的限制,本文结论仍需进一步验证。     

利伐沙班对比低分子肝素预防髋骨骨折患者发生静脉血栓的有效性和安全性的Meta分析

目的:系统评价利伐沙班对比低分子肝素预防髋骨骨折患者发生静脉血栓栓塞(VTE)的有效性和安全性,为临床应用提供循证参考。方法:计算机检索自建库起至2018年6月收录于Cochrane图书馆、PubMed、Embase、中国期刊全文数据库、维普网、万方数据的文献,收集利伐沙班(试验组)对比低分子肝素(对照组)预防髋骨骨折患者发生VTE的随机对照试验(RCT),对符合标准的文献进行资料提取,并采用Cochrane系统评价员手册5.1.0进行质量评价后,采用Rev Man 5.3统计软件对深静脉血栓形成(DVT)发生率、术后引流量、活化部分凝血活酶时间(APTT)水平、凝血酶原时间(PT)及药品不良反应(ADR)发生率进行Meta分析。结果:共纳入8项RCT,合计949例患者。Meta分析结果显示,与低分子肝素相比,利伐沙班能显著降低患者的DVT发生率[RR=0.55,95%CI(0.36,0.83),P=0.004];两组患者的术后引流量[MD=-0.24,95%CI(-5.27,4.8),P=0.93]、APTT[MD=0.56,95%CI(-0.75,1.86),P=0.40]、PT[MD=0.04,95%CI(-0.03,0.11),P=0.25]及ADR发生率[RR=1.73,95%CI(0.15,20.48),P=0.66]比较,差异均无统计学意义。结论:利伐沙班对髋骨骨折患者发生VTE的预防效果优于低分子肝素,且安全性相当。     

复方丹参滴丸改善阿司匹林抵抗有效性和安全性的Meta分析

目的:系统评价复方丹参滴丸改善阿司匹林抵抗的有效性与安全性,为临床用药提供循证参考。方法:计算机检索中国知网、维普网、万方数据、中国生物医学文献数据库、Pub Med、Embase、Cochrane图书馆等数据库,收集复方丹参滴丸(试验组)对比阿司匹林(对照组)的随机对照研究(RCT),检索时限均为各数据库建库起至2020年9月。筛选文献、提取数据后,采用Cochrane系统评价员手册5.1.0推荐的偏倚风险评估工具对纳入文献质量进行评价,采用Rev Man 5.3软件进行Meta分析、发表偏倚分析。结果:共纳入10项RCT,共计800例患者。Meta分析结果显示,试验组患者二磷酸腺苷(ADP)诱导的血小板聚集率(PAR)显著低于对照组[SMD=-2.63,95%CI(-3.56,-1.70),P<0.00001];按治疗周期进行的亚组分析结果显示,治疗2周[SMD=-2.11,95%CI(-2.75,-1.46),P<0.00001]、治疗4周[SMD=-2.84,95%CI(-4.26,-1.41),P<0.0001]、治疗8周[SMD=-2.63,95%CI(-3.21,-2.04),P<0.00001]时试验组患者ADP诱导的PAR均显著低于对照组。试验组患者花生四烯酸(AA)诱导的PAR显著低于对照组[SMD=-2.44,95%CI(-3.64,-1.24),P<0.0001];按治疗周期进行的亚组分析结果显示,治疗2周[SMD=-2.56,95%CI(-3.26,-1.85),P<0.00001]、治疗4周[SMD=-2.45,95%CI(-4.79,-0.10),P=0.04]、治疗8周[SMD=-2.38,95%CI(-2.94,-1.82),P<0.00001]时试验组患者AA诱导的PAR均显著低于对照组。试验组患者治疗后ADP诱导的PAR下降值[SMD=2.24,95%CI(1.36,3.13),P<0.00001]、AA诱导的PAR下降值[SMD=2.42,95%CI(1.94,2.89),P<0.00001]、有效率[RR=8.56,95%CI(4.38,16.74),P<0.00001]均显著高于对照组,试验组患者普通不良反应发生率[RR=0.30,95%CI(0.15,0.60),P=0.0006]、缺血事件发生率[RR=0.13,95%CI(0.07,0.27),P<0.00001]和治疗后CR、PF(P<0.05)均显著低于对照组;两组患者出血事件发生率比较,差异无统计学意义[RR=0.78,95%CI(0.34,1.78),P=0.55]。发表偏倚结果显示,本研究存在发表偏倚的可能性较小。结论:复方丹参滴丸可有效改善患者阿司匹林抵抗,且安全性较好。     

醒脑静注射液辅助治疗肺性脑病疗效的Meta分析

目的:系统评价醒脑静注射液辅助治疗肺性脑病(PE)的疗效。方法:计算机检索中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、维普中文科技期刊全文数据库和万方数字化期刊全文库,纳入醒脑静注射液辅助治疗PE的随机对照试验(RCT),进行方法学质量评价和疗效指标合并分析。结果:经检索得到24个RCT,合计1549例患者,纳入研究存在偏倚风险。Meta分析结果显示,醒脑静组与对照组比较,显效率[RR=1.71,95%CI(1.48,1.97),P<0.00001]、氧分压[MD=13.54,95%CI(10.34,16.74),P<0.00001]、二氧化碳分压[MD=-11.92,95%CI(-14.51,-9.33),P<0.00001]差异都有统计学意义。结论:目前证据表明,PE患者在常规治疗上加用醒脑静注射液能够提高治疗效果。     

氨溴索预防新生儿呼吸窘迫综合征的系统评价

目的:系统评价氨溴索预防新生儿呼吸窘迫综合征(NRDS)的疗效和安全性。方法:计算机检索PubMed、EMBase、ISI、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、中文科技期刊全文数据库(VIP)、万方数字化期刊全文数据库和Cochrane图书馆,纳入氨溴索对比常规/安慰剂预防NRDS的随机对照试验(RCT),对纳入的RCT进行方法学质量评价和Meta分析。结果:共纳入13项RCT,合计1377例患儿。2组NRDS发生率[RR=0.44,95%CI(0.32,0.61),P<0.00001]、发生NRDS后死亡率[RR=0.40,95%CI(0.17,0.94),P=0.03]以及并发症发生率差异均有统计学意义[RR=0.10,95%CI(0.05,0.19),P<0.00001]。2组不良反应发生率比较差异无统计学意义。结论:氨溴索能降低NRDS发生率、减少发生NRDS后的死亡率和并发症。     

社区护理干预对老年糖尿病患者治疗效果影响的Meta分析

目的评价社区护理干预对老年糖尿病治疗效果的影响。方法计算机检索PubMed、EMbase中国生物医学文献数据库(CBM)、万方数据库和中国期刊全文数据库,纳入老年糖尿病社区护理干预的随机对照实验,由2人独立进行数据提取和文献评价。采用RevMan5.0软件进行分析。结果共纳入6个RCT。Meta分析结果显示在血糖控制率[RR=4.07,95%CI(3.08,5.38),P<0.00001]、疾病知识掌握情况[RR=4.43,95%CI(3.26,6.03),P<0.00001]、遵医嘱率[RR=1.72,95%CI(1.31,2.24),P<0.0001]方面均具有统计学意义。结论 Meta分析显示社区护理干预对老年糖尿病的疗效优于传统护理方法。     

经皮扩张气管切开术与外科气管切开术治疗重型颅脑损伤患者的手术质量及并发症的Meta分析

目的:系统评价经皮扩张气管切开术(PDT)与外科气管切开术(ST)救治重型颅脑损伤(sTBI)患者的手术质量及并发症。方法:计算机检索The Cochrane Library,PubMed,EMbase,Web of Science以及中国学术期刊网(CNKI)、中国生物医学文献数据库(CBM)、万方数据库(WanFang Data)和维普数据库(VIP),搜集已公开发表的PDT与ST救治sTBI患者的临床研究文献,检索时限均为建库至2020年6月。由2位评价员按照预先设定的纳入与排除标准独立筛选文献、提取资料并评价纳入研究的偏倚风险,采用Stata12.0软件进行Meta分析。结果:纳入6篇随机对照试验(RCT)、5篇队列研究,共809例患者。Meta分析结果显示,sTBI患者PDT组的手术时间[WMD=-16.21,95%CI(-20.13~-12.29),P<0.00001]、切口长度[WMD=-2.09,95%CI(-2.48~-1.71),P<0.00001]、术中出血量[WMD=-18.68,95%CI(-25.71~-11.64),P<0.00001]、切口愈合时间[WMD=-3.34,95%CI(-5.14~-1.53),P<0.00001]、切口感染率[RR=0.15,95%CI(0.06~0.36),P<0.00001]、术后渗血量[RR=0.36,95%CI(0.19~0.70),P=0.003]、皮下组织/纵隔气肿的发生率[RR=0.16,95%CI(0.06~0.41),P<0.00001]、气胸发生率[RR=0.17,95%CI(0.03~0.95),P=0.044]均明显低(或少)于ST组。结论:现有证据表明,与ST相比,PDT在救治sTBI患者方面具有手术时间短、切口长度小、术中渗血量少、切口愈合时间短、术后并发症发生率低等优点。     

肾功能不全患者应用依诺肝素时的出血风险Meta分析

目的:系统评价肾功能不全患者使用依诺肝素的出血风险。方法:计算机检索Cochrane图书馆临床对照试验资料库、PubMed、EMBase、万方电子期刊、中国知网、中国科技期刊数据库、中国生物医学文献数据库,对纳入的文献进行质量评价与数据提取后,用RevMan 5.1软件对数据进行分析。结果:共纳入10篇文献,包括50 167例患者,文献质量较高。Meta分析结果显示,当GFR<30mL.min-1时,依诺肝素与对照组的出血风险差异无显著性[WMD=1.53,95%CI(0.78,3.00),P=0.21],当GFR<60mL.min-1时,依诺肝素增加了患者的出血风险[WMD=1.67,95%CI(1.12,2.50),P=0.01]。接受依诺肝素治疗时,GFR>30mL.min-1时的出血风险明显高于GFR<30mL.min-1的出血风险[WMD=2.33,95%CI(1.16,4.68),P=0.02],GFR>60mL.min-1时的出血风险明显高于GFR<60mL.min-1n的出血风险[WMD=1.95,95%CI(1.66,2.29),P<0.00001]。结论:在GFR<60mL.min-1时,依诺肝素的剂量调整并没有太明显的效果,出血风险依然明显,因此应该进一步控制GFR<60mL.min-1时依诺肝素的使用。     

铜绿假单胞菌制剂治疗恶性胸腔积液疗效和安全性的Meta分析

目的:系统评价铜绿假单胞菌制剂(PAI)治疗恶性胸腔积液的疗效和安全性,以为临床提供循证参考。方法:计算机检索Cochrane Library、PubMed、EMBase、中国生物医学文献数据库、中国期刊全文数据库、中文科技期刊数据库和万方数据库中关于PAI治疗恶性胸腔积液的随机对照试验(RCT),对纳入的RCT采用Cochrane协作网提供的Rev Man 5.2.9统计软件进行Meta分析。结果:共纳入9项RCT,合计546例患者。Meta分析结果显示,试验组患者完全缓解率[RR=1.65,95%CI(1.25,2.17),P<0.000]、部分缓解率[RR=1.49,95%CI(1.20,1.85),P<0.000]、稳定率[RR=0.42,95%CI(0.30,0.58),P<0.000]、进展率[RR=0.35,95%CI(0.19,0.64),P<0.000]均显著优于对照组,两组比较差异有统计学意义。亚组分析显示,两组患者不良反应发生率比较差异无统计学意义[RR=1.15,95%CI(0.91,1.46),P>0.05;RR=0.61,95%CI(0.32,1.17),P>0.05]。结论:PAI治疗恶性胸腔积液可以提高临床疗效,降低不良反应发生率,但该结论仍需要高质量、大样本的RCT进一步来验证。     

参芪扶正注射液治疗胃癌疗效的系统评价

目的:系统评价参芪扶正注射液治疗胃癌的疗效。方法:电子检索Cochrane(2011年第3期),PubMed(1966-2011.9),EMBASE(1974-2011.9),CBM(1978-2011.9),VIP(1989-2011.9),CNKI数据库(1994-2011.09);手工检索相关杂志。纳入参芪扶正注射液治疗胃癌的随机对照试验(RCT),对纳入的RCT进行质量评价,并用RevMan5.0软件对数据进行Meta分析。结果:共纳入9个RCT,Meta分析结果显示:参芪扶正注射液联合常规化疗治疗胃癌的近期疗效的有效率明显高于单用常规化疗组,且差异具有统计学意义[RR=1.54,95%CI(1.25,1.89),P<0.0001],治疗前后生活质量改善率,治疗组明显高于对照组[RR=3.14,95%CI(2.11,4.69),P<0.00001]。结论:本系统评价结果显示,常规化疗联合参芪扶正注射液治疗胃癌的疗效优于常规化疗,但因纳入研究质量较低,尚需高质量、大样本、长期的随机对照试验进一步验证上述结论。     

低分子肝素联合糖皮质激素治疗小儿肾病综合征疗效及安全性的Meta 分析

目的:评估低分子肝素联合糖皮质激素治疗小儿肾病综合征(NS)的疗效及安全性。 方法:检索 PubMed、the Cochrane Library、EMBase、中国知网、中国生物医学文献数据库、维普、万方数据库,检索时间从建库至 2021 年 3 月,收集低分子肝素联合 糖皮质激素治疗小儿 NS 的临床随机对照试验(RCT),根据 Cochrane 推荐的偏倚风险评估方法对纳入的 RCT 研究进行风险评估,使用 RevMan 5. 3 软件进行统计学分析。 结果:共纳入 16 篇 RCT,病例共计 1 348 例。 Meta 分析结果显示:与单用糖皮质激素(泼尼松)治疗小儿 NS 相比,低分子肝素+泼尼松治疗在活化部分凝血活酶时间、血浆凝血酶原时间、不良反应发生率方面差异无统计学意义(P 均>0. 05),在改善 24 h 尿蛋白定量、血清白蛋白、尿素氮、血肌酐清除率、血肌酐及血浆胆固醇水平方面差异有统计学意义(P 均<0. 05)。 结论:低分子肝素联合糖皮质激素较单用激素治疗小儿 NS 疗效更优,但仍需大样本、多指标的RCT 对远期疗效及药物不良反应等展开深入评估。     

A comparison of observational studies and controlled trials of heparin in ulcerative colitis

OBJECTIVES: To compare the efficacy of heparin in ulcerative colitis (UC) as demonstrated in observational studies and controlled clinical trials. INTRODUCTION: Ulcerative colitis (UC) is a chronic condition with a relapsing and remitting course. Several studies have been conducted (observational and controlled clinical trials) to test the usefulness of heparin in this condition but the results of these studies are variable. Some studies demonstrate efficacy while others do not. METHODS: We pooled the results of observational studies and clinical trials separately in order to compare the results of observational studies and clinical trials using meta-analysis. With the aid of Medline and a manual search in Index Medicus and cross-references of articles published up to July 2003, we identified studies designed to evaluate the effects of heparin on UC. The pooled cure rate in observational studies was calculated. RESULTS: The results of controlled clinical trials evaluated using meta-analysis showed that the pooled cure rate for observational studies was 87.7% (range 80 - 100). The odds ratio for the controlled trial was 0.34 (95% CI 0.08 - 1.49) using a random effects model and 0.21 (95% CI 0.06 - 1.38) using a fixed effects model. The results of meta-analysis demonstrate a non-significant effect of heparin in controlled clinical trials. CONCLUSION: The findings of the clinical trials differ markedly from observational studies and indicate a lack of efficacy of heparin in patients with ulcerative colitis.     

低分子肝素对照阿司匹林治疗短暂性脑缺血发作疗效和安全性的Meta分析

目的系统评价低分子肝素与阿司匹林治疗短暂性脑缺血发作的疗效和安全性。方法计算机检索PubMed(1966年10月～2011年5月)、EMbase(1974年10月～2011年5月)、Cochrane图书馆(至2011年第3期)、中国生物医学文献数据库(CBM,1978年10月～2011年5月)、中国期刊全文数据库CNKI(1994年10月～2011年5月)、中文科技期刊全文数据库(VIP,1989年10月～2011年5月)获取相关随机对照试验。按照Cochrane系统评价的方法评价纳入研究的质量,并使用Cochrane协作网提供的RevMan4.2.8软件进行统计分析。结果本研究最终纳入11个随机对照试验,总共731例。固定效应模型分析结果显示总有率的Meta分析的合并效应量OR合并=4.93,95%CI为2.85～8.55,合并效应量的检验(Z=5.69,P<0.01)提示低分子肝素组和阿司匹林组总有效率差异有统计学意义;恶化率的Meta分析结果显示差异有统计学意义(R合并=0.22,95%CI为0.11～0.45,P<0.01)。安全性方面,低分子肝素组报道有27例发生皮肤瘀斑,8例发生牙龈出血,但未影响治疗全过程。结论低分子肝素治疗短暂性脑缺血发作的总有效率高于阿司匹林组;在恶化率方面,低分子肝素治疗短暂性脑缺血发作的恶化率低于阿司匹林组。由于本系统评价纳入的文献质量较低、数量较少,且有些文献病例数较少,因此尚需开展更多设计合理、执行严格的多中心大样本的随机对照试验验证本研究的结论。     

低分子肝素与普通肝素用于冠脉内支架置入术患者疗效比较

目的:观察冠脉内支架置入术后低分子肝素和普通肝素的临床疗效。方法:将研究对象49例分为普通肝素组22例及低分子肝素组27例。观察两组急性、亚急性支架内血栓形成发生例数及术后半个月内严重心脏事件的发生情况。统计两组出血副作用的发生例数。结果:低分子肝素组发生急性、亚急性支架内血栓形成及术后半个月内心脏严重事件的发生例数均低于普通肝素组,但无统计学差异(P>0．05)。低分子肝素组出血发生率明显低于普通肝素组(P<0．05)。结论:低分子肝素抗凝疗效与普通肝素相似,而出血事件明显少于普通肝素,且无需监测,值得推广应用。     

Heparin mimetics

Explorations of the therapeutic potential of heparin mimetics, anionic compounds that are analogues of glycosaminoglycans (GAGs), have gone hand-in-hand with the emergence of understanding as to the role of GAGs in many essential biological processes. A myriad of structurally different heparin mimetics have been prepared and examined in many diverse applications. They range in complexity from heterogeneous polysaccharides that have been chemically sulphated to well-defined compounds, designed in part to mimic the natural ligand, but with binding specificity and potency increased by conjugation to non-carbohydrate pharmacophores. The maturity of the field is illustrated by the seven heparin mimetics that have achieved marketing approval and there are several more in late-stage clinical development. An overview of the structural determinants of heparin mimetics is presented together with an indication of their activities. The challenges in developing heparin mimetics as drugs, specificity and potential toxicity issues, are highlighted. Finally, the development path of three structurally very different mimetics, PI-88(?), GMI-1070 and RGTAs, each of which is in clinical trials, is described.     

肝素中存在的一个不易被亚硝酸降解的片段

对猪肠粘膜来源肝素进行亚硝酸控制解聚得到的各个低分子量肝素（LMWH）的高效液相色谱（HPLC）图谱分析发现一个共有的、位置稳定的特征峰。该峰对应于12～14个糖残基组成的、分子量约为3900的寡糖链。此糖链对亚硝酸作用有抗御性,其存在有助于LMWH分子量的测定和校正。     

Bivalirudin: a pharmacoeconomic profile of its use in patients with acute coronary syndromes

Bivalirudin (Angiox?; Angiomax?), a direct thrombin inhibitor, is an intravenous anticoagulant. The efficacy of bivalirudin in the management of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) or ST-segment elevation myocardial infarction (STEMI) planned for invasive interventions has been shown in large, pivotal, open-label trials. Bivalirudin provided similar ischaemic protection to heparin plus a glycoprotein (GP) IIb/IIIa inhibitor, but with a significant reduction in bleeding events, in patients with NSTE-ACS planned for urgent or early intervention and those with STEMI planned for primary percutaneous coronary intervention (PCI). Mortality rates were also significantly lower in patients with STEMI receiving bivalirudin than in those receiving heparin plus a GP IIb/IIIa inhibitor in the key trial of patients with STEMI. Based on this clinical data, modelled cost-utility analyses from the perspective of various UK NHS providers have predicted that bivalirudin would be highly likely to be cost effective with regard to the cost per QALY gained relative to a heparin plus GP IIb/IIIa inhibitor-based strategy over a lifetime horizon in these patient populations. In patients with NSTE-ACS planned for urgent or early invasive intervention, a bivalirudin-based strategy was considered to be cost effective in the UK, Scotland and Wales. In patients with STEMI planned for primary PCI, a bivalirudin-based strategy was dominant in the UK and Scotland. Parallel and sensitivity analyses demonstrated that base-case conclusions were robust over a range of plausible changes in parameter estimates and assumptions, including changes made to more closely reflect current local clinical practice. In addition, budgetary impact analyses in several countries suggested that the implementation of a bivalirudin-based strategy, instead of a heparin plus GP IIb/IIIa inhibitor-based strategy, would be cost saving from a hospital perspective in patients with NSTE-ACS undergoing urgent or early PCI, as well as in patients with STEMI undergoing primary PCI. Likewise, prospective and retrospective treatment cost studies in the US indicated that treatment with bivalirudin was less costly than treatment with heparin plus a GP IIb/IIIa inhibitor in these indications. In conclusion, available pharmacoeconomic data from several countries, despite some inherent limitations, support the use of strategies based on bivalirudin over those based on heparin plus a GP IIb/IIIa inhibitor in patients with NSTE-ACS planned for urgent or early invasive intervention or STEMI planned for primary PCI. These pharmacoeconomic advantages primarily reflect that, relative to heparin plus a GP IIb/IIIa inhibitor, bivalirudin is associated with lower rates of bleeding over the short term, and is associated with lower rates of early mortality that are subsequently maintained over the longer term in patients with STEMI.     

Comparative Studies of Heparin and Heparin Fragments: Distribution and Toxicity in the Rat

Comparative Studies of Heparin and Heparin Fragments: Distributionand Toxicity in the Rat. Larsen, A. K., Newberne, P. M., andLanger, R. (1986). Fundam Appl. Toxicol 7, 86-93. To controlblood levels of hepann during extracorporeal therapy, the useof a blood filter containing heparinase, a heparin-specificenzyme that cleaves heparin to small fragments with less anticoagulantactivity, has been proposed. These fragments have anti-factorXa activity but no anti-thrombin activity. The potential toxicityof heparin fragments as compared to heparin was examined inrats by identifying presumptive sites of drug-related toxicityby whole-body autoradiography and by histological examinationof major organs. Radioautograms of rats sacrificed 5 hr afterdosing with [³⁵S]heparin fragments indicated no potential targetsdifferent from what was observed in rats dosed with [³⁵S]heparin.In addition, the faster urinary clearance of heparin fragmentsresulted in a lower concentration of these fragments than ofheparin in all common target organs. No hemorrhages or otherlesions were found in rats injected intravenously with heparinfragments (100 mg/kg) and sacrificed after 5 hr. In addition,no mortality or delayed toxic effects were observed in a similargroup of animals sacrificed 2 weeks after dosing. In contrast,80% of rats injected with heparin (100 mg/kg) showed hemorrhagesof the lungs at the time of necropsy.     

Meta-analysis: The utility and safety of heparin in the treatment of active ulcerative colitis

BACKGROUND: The use of heparin for the treatment of ulcerative colitis has been evaluated in several open and controlled trials, with varying outcomes. AIM: To evaluate the efficacy and safety of heparin as supplemental therapy compared with conventional therapy in patients with ulcerative colitis. METHODS: All randomized trials comparing heparin supplementation to conventional therapy were included from electronic databases. Statistical analysis was performed with review manager 4.2.8 (The Cochrane Collaboration, Oxford, UK). Sub-analysis and sensitivity analysis were also performed. RESULTS: Eight randomized-controlled trials, investigating a total of 454 participants, met the inclusion criteria. The odds ratio (OR) for the efficacy of heparin supplementation vs. conventional therapy was 0.78 (95% CI = 0.50-1.21). Few serious adverse events were observed. The OR for the efficacy of unfractionated heparin and low-molecular-weight heparin vs. conventional therapy was 0.26 (95% CI = 0.07-0.93) and 0.92 (95% CI = 0.57-1.47), respectively. The OR for the efficacy of heparin vs. conventional therapy with placebo was 0.87 (95% CI = 0.53-1.44). CONCLUSIONS: Our meta-analysis suggests that administration of heparin in patients with ulcerative colitis is safe, but no additive benefit over conventional therapy is indicated.     

Enoxaparin: a review of its use in ST-segment elevation myocardial infarction

Enoxaparin (enoxaparin sodium; Lovenox) is a low-molecular-weight heparin (LMWH) that has recently been approved by the US FDA for use in patients with medically managed ST-segment myocardial infarction (STEMI), or STEMI with subsequent percutaneous coronary intervention (PCI). It binds to and potentiates the action of antithrombin, and inhibits coagulation factors XIa, IXa, Xa and IIa (thrombin), thereby preventing formation of blood clots. Unfractionated heparin (UFH) has long been regarded as the antithrombotic agent of choice in the adjunctive treatment of patients with STEMI. However, compared with UFH, enoxaparin has many advantages in terms of its pharmacodynamic profile and, potentially, also its efficacy. Enoxaparin was significantly more effective than UFH in patients presenting with STEMI who underwent fibrinolytic therapy in terms of the 30-day combined incidence of all-cause mortality plus recurrent nonfatal myocardial infarction (MI) [primary endpoint], and all-cause mortality plus recurrent nonfatal MI plus urgent revascularization (secondary endpoint) in the ExTRACT-TIMI 25 trial. The significant difference in the incidence of the composite primary endpoint between these two groups was maintained at the 1-year follow-up. Although bleeding was reported more frequently with enoxaparin than with UFH in the ExTRACT-TIMI 25 trial, enoxaparin was associated with a net clinical benefit relative to UFH. Patients in this trial received enoxaparin as an initial 30 mg intravenous bolus, followed by 1 mg/kg subcutaneously within 15 minutes and then every 12 hours for up to 8 days; the first two subcutaneous dosages were not to exceed 100 mg. Patients > or =75 years of age did not receive the initial bolus of enoxaparin and the 12-hourly dosages were reduced to 0.75 mg/kg; the dose was also reduced to 1 mg/kg every 24 hours in patients of any age who had an estimated creatinine clearance (CL(CR)) of <30 mL/min. Data from several earlier randomized, multicentre, phase III trials support these results.