Comparison of Prophylactic and Therapeutic Doses of Anticoagulation for Acute Chest Syndrome in Sickle Cell Disease: The TASC Double-Blind Controlled Randomized Clinical Trial.

Objectives: We evaluated whether therapeutic anticoagulation could shorten ACS duration.

目标：我们评估了治疗性抗凝是否能缩短ACS的持续时间。

Methods: TASC (Therapeutic Anticoagulation for Acute Chest Syndrome in Sickle Cell Disease) is a randomized, controlled, double-blindtrial conducted in 12 French hospitals (December 2016-April 2021) in adult patients with ACS with no initial thrombosis on chest computed tomography with pulmonary angiogram.

方法：TASC（镰状细胞病急性胸综合征的治疗性抗凝）是一项在12家法国医院（2016年12月至2021年4月）进行的随机、对照、双盲试验，研究对象为成年急性胸综合征患者，这些患者在胸部计算机断层扫描和肺动脉造影中没有初始血栓形成。

We randomized 172 patients (1:1) to receive either prophylactic or therapeutic doses of low-molecular-weight tinzaparin for 7 days.

我们对172名患者（1:1）进行了随机分组，分别接受低分子量替唑肝素的预防剂量或治疗剂量，持续7天。

The primary efficacy outcome was time to ACS resolution.

主要疗效终点是急性冠脉综合征（ACS）缓解的时间。

The primary safety outcome was major bleeding.

主要安全性终点是重大出血事件。

Main secondary outcomes included parenteral opioid consumption, transfusion, mortality at hospital discharge, and hospital readmissions at 6 months.

主要次要结果包括住院期间的肠外阿片类药物使用量、输血情况、出院时的死亡率以及6个月内的再次住院情况。

Measurements and Main Results: The primary efficacy outcome, time to ACS resolution, analyzed using a Cox model, was shorter with therapeutic anticoagulation than with prophylactic doses (hazard ratio, 0.71; 95% confidence interval, 0.51 to 0.99; P = 0.044).

测量和主要结果：主要疗效结果，即急性冠状动脉综合征（ACS）缓解的时间，使用Cox模型分析显示，治疗性抗凝治疗比预防性剂量的抗凝治疗时间更短（风险比，0.71；95%置信区间，0.51至0.99；P = 0.044）。

As a supplemental estimate, the restricted mean time to ACS resolution (over a 15-d horizon or discharge) was shorter with therapeutic doses (4.8 ± 0.4 vs. 6.1 ± 0.5 d).

作为补充估计，治疗剂量下急性冠脉综合征（ACS）解决的限制性平均时间（在15天的范围内或出院）较短（4.8 ± 0.4天 vs. 6.1 ± 0.5天）。

The primary safety outcome (major bleeding) did not occur in either group.

主要的安全性结果（主要出血）在两组中均未发生。

The cumulative dose of parenteral opioids was lower with therapeutic anticoagulation: median [interquartile range] of 124 [80 to 272] vs. 219 [65 to 378] mg morphine equivalent; difference, -96; 95% confidence interval, -202 to -46; P = 0.02.

治疗性抗凝治疗组的静脉阿片类药物累积剂量较低：中位数[四分位数间距]为124[80至272]毫克吗啡当量，而非抗凝治疗组为219[65至378]毫克吗啡当量；差异为-96；95%置信区间为-202至-46；P = 0.02。

Other short- and long-term secondary outcomes were similar between groups.

其他短期和长期次要结果在两组之间相似。

Conclusions: In adult patients with ACS, a therapeutic anticoagulation shortened ACS duration and reduced opioid consumption compared with prophylactic doses, without increasing bleeding risk.

结论：在成人急性冠脉综合征（ACS）患者中，治疗性抗凝缩短了ACS持续时间并减少了阿片类药物的消耗，与预防性剂量相比，并没有增加出血风险。

Clinical trial registered with www.clinicaltrials.gov (NCT02580773).

临床试验已在www.clinicaltrials.gov注册（NCT02580773）。