文献标题：Unfractionated or Low–Molecular Weight Heparin for the Treatment of Cerebral Venous Thrombosis
文献出处：Stroke. 2010.10.7
期刊影响因子：7.041
一项新的关于脑静脉血栓形成患者的研究提示，低分子量肝素比普通肝素具有更好的有效性和安全性。对于脑静脉血栓形成的首次治疗，低分子量肝素似乎比普通肝素更为合适。
研究采用了前瞻性队列研究（大脑静脉与硬脑膜窦血栓的国际性研究），对624例脑静脉血栓形成患者进行非随机化对照研究。第一阶段分析：之前未应用肝素治疗的患者（n=107）以及同时使用两种类型肝素的患者（n=99）。而后者包含在第二阶段的分析当中。分组依据患者首次使用肝素的种类。主要终点为6个月时功能性自立（mRs量表评分：2）；次要终点为治愈率（mRs量表评分：0-1），死亡率，以及新发的颅内出血。
结果，共有119名患者采用低分子量肝素的治疗（28%），302名患者采用普通肝素治疗（72%）。值得注意的是，应用低分子量肝素治疗的患者于6个月后出现功能性自立，且都使用了单变量分析（比值比，2.1；可信区间，1.0至4.2）与预后因素及失衡的修正（比值比，2.4；可信区间，1.0至5.7），在第二阶段分析中，存在着类似的无显著意义的趋势（比值比，1.7；可信区间，0.8至3.6），低分子量肝素组几乎无新发脑内出血病例（修正比值比，0.29；可信区间，0.07至1.3），特别是基准线上颅脑损伤患者（修正比值比，0.19；可信区间，0.04至0.99）治愈率与死亡率无明显差异。
医脉通推荐英文原文摘要
Stroke. 2010,doi: 10.1161/STROKEAHA.110.588822
Unfractionated or Low–Molecular Weight Heparin for the Treatment of Cerebral Venous Thrombosis
Jonathan M. Coutinho, MD; José M. Ferro, MD, PhD; Patrícia Canhão, MD
Background and Purpose
There is no consensus whether to use unfractionated heparin or low–molecular weight heparin for the treatment of cerebral venous thrombosis. We examined the effect on clinical outcome of each type of heparin.
Methods
A nonrandomized comparison of a prospective cohort study (the International Study on Cerebral Vein and Dural Sinus Thrombosis) of 624 patients with cerebral venous thrombosis. Patients not treated with heparin (n=107) and those who sequentially received both types of heparin (n=99) were excluded from the primary analysis. The latter were included in a secondary analysis, allocated according to the type of heparin given first. The primary end point was functional independency at 6 months (modified Rankin scale score 2). Secondary end points were complete recovery (modified Rankin scale score 0 to 1), mortality, and new intracranial hemorrhages.
Results
A total of 119 patients received low–molecular weight heparin (28%) and 302 received unfractionated heparin (72%). Significantly more patients treated with low–molecular weight heparin were functionally independent after 6 months, both in univariate analysis (odds ratio, 2.1; CI, 1.0 to 4.2) and after adjustment for prognostic factors and imbalances (odds ratio, 2.4; CI, 1.0 to 5.7). In the secondary analysis, there was a similar, nonsignificant trend (odds ratio, 1.7; CI, 0.80 to 3.6). Low–molecular weight heparin was associated with less new intracerebral hemorrhages (adjusted odds ratio, 0.29; CI, 0.07 to 1.3), especially in patients with intracerebral lesions at baseline (adjusted odds ratio, 0.19; CI, 0.04 to 0.99). There was no difference in complete recovery and mortality.
Conclusions
This nonrandomized study in patients with cerebral venous thrombosis suggests a better efficacy and safety of low–molecular weight heparin over unfractionated heparin. Low–molecular weight heparin seems preferable above unfractionated heparin for the initial treatment of cerebral venous thrombosis.
文献来源
Jonathan M. Coutinho, MD;José M. Ferro, MD, PhD; Patrícia Canh?o, MD.Unfractionated or Low–Molecular Weight Heparin for the Treatment of Cerebral Venous Thrombosis.Stroke. 2010 [PubMed链接 | 期刊网站链接]
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