ObjectiveTo systematically review the efficacy and safety of different low-molecular-weight heparins (LMWHs) for prevention of thromboembolic events in patients with atrial fibrillation (AF).MethodsPubMed, The Cochrane Library, EMbase, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized clinical trials (RCTs) on efficacy and safety of different low-molecular-weight heparins (LMWHs) in preventing thrombotic diseases in patients with atrial fibrillation from inception to March 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, meta-analysis was performed by using Stata 16.0 software.ResultsA total of 11 RCTs involving 7 400 patients who were treated with enoxaparin, dalteparin, or tinzaparin to prevent thromboembolic events were included. The results of network meta-analysis showed that: in patients with AF and perioperative AF patients, there were no statistical differences in the incidence of stroke, TIA, major bleeding, minor bleeding, and all-cause mortality caused by dalteparin, enoxaparin, and tinzaparin. Furthermore, the surface under the cumulative ranking area (SUCRA) showed that enoxaparin was superior for prevention of stroke and TIA than dalteparin and tinzaparin. As for major bleeding, minor bleeding, and all-cause death, dalteparin treatment was superior than enoxaparin.ConclusionsCurrent evidence showed enoxaparin to be a viable option for high ischemic risk AF patients requiring LWMH treatment, while dalteparin to be a viable option for those with bleeding high risk. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
Spinal cord injury (SCI) patients are high-risk groups of hospitalized patients with venous thrombosis embolism (VTE). VTE is one of the important causes of inpatients’ unexpected death and perioperative accidental death, so SCI patients with VTE deserve special attention. In recent years, the risk factors, epidemiological characteristics, pathogenesis, and prevention of VTE have been further understood. We also have a more comprehensive and in-depth understanding of the treatment of venous thrombosis, including general prevention, drug, interventional surgery, rehabilitation, etc. Non-invasive examination, new therapeutic technologies, and new oral anticoagulant drugs have also greatly promoted the prevention and treatment of VTE. Meanwhile, prevention system of VTE has been developed from single subject work gradually to the multidisciplinary, multiple grades and doctor-patient cooperation mode, is no longer just dominated by clinical departments, but dominated by hospitals and even higher level department, and a more scientific and effective management mode has being under construction, all of these will further optimize the clinical prevention and treatment of venous thrombosis.
