比伐卢定
医学
体外膜肺氧合
子群分析
内科学
荟萃分析
直接凝血酶抑制剂
科克伦图书馆
肝素
血栓形成
心脏病学
心肌梗塞
经皮冠状动脉介入治疗
心房颤动
华法林
达比加群
作者
Liyao Liu,Feng Liu,Jixiang Tan,Lin Zhao
标识
DOI:10.1016/j.phrs.2022.106089
摘要
Our study sought to investigate the efficacy and safety of bivalirudin versus those of unfractionated heparin (UFH) in patients undergoing extracorporeal membrane oxygenation (ECMO).PubMed, EMBASE and Cochrane Library were searched for studies enrolling ECMO patients on bivalirudin and UFH (from inception till July 2021). Meta-analysis was conducted. The I2 statistic and p value were used in measuring heterogeneity, and random effects or fixed-effect model was adopted. The Newcastle-Ottawa Scale was used for the risk of bias assessment. Sensitivity and subgroup analyses were undertaken. We performed Egger's test to evaluate publication bias.Fourteen eligible retrospective observational studies with 1501 subjects were identified. Compared with UFH, bivalirudin significantly reduced the risk of in-circuit thrombosis (OR = 0.44, 95% CI [0.31-0.61], p = 0.000), thrombosis (OR = 0.61, 95% CI [0.45-0.83], p= 0.002) and hospital mortality (OR = 0.78, 95% CI [0.61-0.99], p = 0.04) and had a positive impact on survival ECMO (OR = 1.50, 95% CI [1.04-2.16], p= 0.032). Decrease in risk of bleeding (OR = 0.36, 95% CI [0.14-0.91], p = 0.031) associated with bivalirudin was observed. Sources of heterogeneity were identified, and sensitivity analysis revealed similar results.Our meta-analysis suggested that bivalirudin was associated with the decreased risk of in-circuit thrombosis, thrombosis, hospital mortality and bleeding in patients on ECMO and improved survival ECMO, indicating the superiority of bivalirudin to UFH in terms of efficacy and safety.
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