摘要
背景：治疗sT段抬高型急性心肌梗死（STEMI）时，推荐在给予纤维蛋白特异性药物溶栓后静脉使用普通肝素（UFH）。皮下注射低分子肝素（LMWH）已在非ST段抬高型急性冠状动脉综合征中被证实有效，近期已对其在STEMI中的疗效进行探讨。本研究旨在评价支持在STEMI中使用LMWH的现有证据水平。方法：在Medline数据库中检索1995年1月至2005年12月间发表的英文文献，将比较LMWH与安慰剂／UFH联合溶栓治疗效果的随机临床试验纳入分析。结果：共12项随机对照试验、约26800例接受各种溶栓方案的患者被纳入分析。达肝素对左室血栓形成／心房血栓栓塞的疗效优于安慰剂，但对梗死相关动脉（IRA）的早期再通率无明显影响。与UFH相比，达肝素对临床事件发生率和IRA晚期再通率无显著影响，尽管血栓形成较少。
Background： Intravenous unfractionated heparin（UFH） is recommended in ST-elevation acute myocardial infarction （STEMI）, following thrombolysis with fibrin-specific agents. Subcutaneous low-molecular-weight heparins （LMWH）, previously proven effective in non-ST-elevation acute coronary syndromes, have been recently investigated in the setting of STEMI. We aimed at evaluating the cur- rent level of evidence supporting the use of LMWH in STEMI. Methods： A Medline search of the English language literature between January 1995 and December 2005 was performed and randomized clinical trials comparing LMWH to either placebo or UFH in conjunction with thrombolysis were selected. Results： About 26, 800 patients treated with various thrombolytic regimens were included in 12 randomized clinical trials.
