Recent studies suggest that low-molecular-weight heparin (LMWH) may play a role in mitigating the severity of acute pancreatitis (AP). This systematic review and meta-analysis aims to synthesise existing evidence on the effectiveness and safety of LMWH in the treatment of moderately-severe and severe AP. This systematic review and meta-analysis was conducted in accordance with the 2020 update of the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The systematic search was conducted in MEDLINE, the Cochrane Central Register of Controlled Trials, Scopus, and EMBASE, covering studies published up to February 2024. Randomised controlled trials (RCTs) and observational studies (n-RCTs) that reported the differences in the outcomes of AP for patients receiving LMWH in addition to the standard treatment (Intervention), compared to patients managed by standard treatment without LMWH (Control) were eligible. A random-effects model was used to calculate the pooled relative risk (RR) and mean differences (MD) with the corresponding 95% CI. Thirteen studies were included in the meta-analysis, all published between 2004 and 2022. Eight studies were RCTs, and five were n-RCTs. Data from 13,709 patients (6.971 Interventions and 6.738 Controls) were analysed. The comparison of Intervention and Control groups showed the superiority of LMWH to standard treatments in terms of overall mortality (RR = 0.44, 95% CI = 0.31; 0.64, P < 0.0001, I2 = 51%), acute necrotic collections (RR = 0.24, 95% CI = 0.09; 0.62, P = 0.003, I2 = 0%), and organ failure (RR = 0.67, 95% CI = 0.48; 0.93, P = 0.02, I2 = 78%). The Intervention group showed superior outcomes compared with the Control group for gastrointestinal bleeding (RR = 0.64, 95% CI = 0.44; 0.94, P = 0.02, I2 = 0%), length of hospital stay (MD= − 6.08, 95% CI = − 10.08; − 2.07, P = 0.003, I2 = 98%), need for operative interventions (RR = 0.50, 95% CI = 0.29; 0.87, P = 0.01, I2 = 61%), and vascular thrombosis (RR = 0.43, 95% CI = 0.31; 0.61, P < 0.00001, I2 = 0%). Moderate to high-quality evidence suggests that early intervention with LMWH could improve the prognosis of non-mild AP in terms of mortality, organ failure, and decreased incidence of vascular thrombosis. In light of our findings, integrating LMWH into the treatment regimen for moderate-severe to severe AP is advocated.

中文翻译：

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低分子肝素治疗急性胰腺炎的有效性和安全性：系统评价和荟萃分析


最近的研究表明，低分子量肝素（LMWH）可能在减轻急性胰腺炎（AP）的严重程度方面发挥作用。本系统评价和荟萃分析旨在综合 LMWH 治疗中重度和重度 AP 的有效性和安全性的现有证据。本次系统评价和荟萃分析是根据 2020 年更新的 PRISMA 指南和 Cochrane 干预系统评价手册进行的。系统检索在 MEDLINE、Cochrane 对照试验中央注册库、Scopus 和 EMBASE 中进行，涵盖截至 2024 年 2 月发表的研究。报告结果差异的随机对照试验 (RCT) 和观察性研究 (n-RCT)与接受标准治疗但不接受 LMWH（对照）的患者相比，接受 LMWH 加标准治疗（干预）的患者的 AP 合格率。使用随机效应模型计算汇总相对风险 (RR) 和平均差 (MD) 以及相应的 95% CI。荟萃分析中纳入了 13 项研究，全部发表于 2004 年至 2022 年间。8 项研究为 RCT，5 项为 n-RCT。分析了 13,709 名患者（6.971 名干预患者和 6.738 名对照患者）的数据。干预组和对照组的比较显示，在总死亡率（RR = 0.44，95% CI = 0.31；0.64，P < 0.0001，I2 = 51%）、急性坏死聚集（RR = 0.24，95% CI = 0.09；0.62，P = 0.003，I2 = 0%），以及器官衰竭（RR = 0.67，95% CI = 0.48；0.93，P = 0.02，I2 = 78%）。与对照组相比，干预组在胃肠道出血方面表现出更好的结果（RR = 0.64，95% CI = 0.44；0.94，P = 0。02，I2 = 0%），住院时间（MD= − 6.08，95% CI = − 10.08；− 2.07，P = 0.003，I2 = 98%），需要手术干预（RR = 0.50，95% CI = 0.29；0.87，P = 0.01，I2 = 61%）和血管血栓（RR = 0.43，95% CI = 0.31；0.61，P < 0.00001，I2 = 0%）。中等到高质量的证据表明，早期使用 LMWH 进行干预可以改善非轻度 AP 的预后，包括死亡率、器官衰竭和降低血管血栓形成的发生率。根据我们的研究结果，建议将 LMWH 纳入中重度至重度 AP 的治疗方案中。