| Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. | |
| | |
MedLine Citation:
|
PMID: 15495007 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Low molecular weight heparins (LMWH) have been shown to be effective and safe in preventing venous thromboembolism (VTE), and may also be effective for the initial treatment of VTE. OBJECTIVES: To determine the effect of LMWH compared with unfractionated heparin (UFH) for the initial treatment of VTE. SEARCH STRATEGY: Trials were identified from the Cochrane Peripheral Vascular Diseases Group's Specialised Register, CENTRAL and LILACS. Colleagues and pharmaceutical companies were contacted for additional information. SELECTION CRITERIA: Randomised controlled trials comparing fixed dose subcutaneous LMWH with adjusted dose intravenous or subcutaneous UFH in people with VTE. DATA COLLECTION AND ANALYSIS: At least two reviewers assessed trials for inclusion and quality, and extracted data independently. MAIN RESULTS: Twenty-two studies were included (n = 8867). Thrombotic complications occurred in 151/4181 (3.6%) participants treated with LMWH, compared with 211/3941 (5.4%) participants treated with UFH (odds ratio (OR) 0.68; 95% confidence intervals (CI) 0.55 to 0.84, 18 trials). Thrombus size was reduced in 53% of participants treated with LMWH and 45% treated with UFH (OR 0.69; 95% CI 0.59 to 0.81, 12 trials). Major haemorrhages occurred in 41/3500 (1.2%) participants treated with LMWH, compared with 73/3624 (2.0%) participants treated with UFH (OR 0.57; 95% CI 0.39 to 0.83, 19 trials). In eighteen trials, 187/4193 (4.5%) participants treated with LMWH died, compared with 233/3861 (6.0%) participants treated with UFH (OR 0.76; 95% CI 0.62 to 0.92). Nine studies (n = 4451) examined proximal thrombosis; 2192 participants treated with LMWH and 2259 with UFH. Subgroup analysis showed statistically significant reductions favouring LMWH in thrombotic complications and major haemorrhage. By the end of follow up, 80 (3.6%) participants treated with LMWH had thrombotic complications, compared with 143 (6.3%) treated with UFH (OR 0.57; 95% CI 0.44 to 0.75). Major haemorrhage occurred in 18 (1.0%) participants treated with LMWH, compared with 37 (2.1%) treated with UFH (OR 0.50; 95% CI 0.29 to 0.85). Nine studies (n = 4157) showed a statistically significant reduction favouring LMWH with respect to mortality. By the end of follow up, 3.3% (70/2094) of participants treated with LMWH had died, compared with 5.3% (110/2063) of participants treated with UFH (OR 0.62; 95% CI 0.46 to 0.84). REVIEWERS' CONCLUSIONS: LMWH is more effective than UFH for the initial treatment of VTE. LMWH significantly reduces the occurrence of major haemorrhage during initial treatment and overall mortality at follow up. |
| | |
Authors:
|
C J J van Dongen; A G M van den Belt; M H Prins; A W A Lensing |
Related Documents
:
|
9609217 - Low molecular weight heparin decreases proximal and distal deep venous thrombosis follo... 22691217 - Clinical trial design in scleroderma: where are we and where do we go next? 18345947 - Warfarin therapy: in need of improvement after all these years. 11498067 - Low-molecular-weight heparin versus warfarin for secondary prophylaxis of venous thromb... 9726737 - Pulmonary wegener's granulomatosis: correlation between high-resolution ct findings and... 11851727 - D-penicillamine reduces serum oxidative stress in alzheimer's disease patients. |
Publication Detail:
|
Type: Journal Article; Meta-Analysis; Review Date: 2004-10-18 |
Journal Detail:
|
Title: Cochrane database of systematic reviews (Online) Volume: - ISSN: 1469-493X ISO Abbreviation: Cochrane Database Syst Rev Publication Date: 2004 |
Date Detail:
|
Created Date: 2004-10-20 Completed Date: 2005-03-23 Revised Date: 2010-09-23 |
Medline Journal Info:
|
Nlm Unique ID: 100909747 Medline TA: Cochrane Database Syst Rev Country: England |
Other Details:
|
Languages: eng Pagination: CD001100 Citation Subset: IM |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Heparin
/
administration & dosage,
adverse effects Heparin, Low-Molecular-Weight / administration & dosage*, adverse effects Humans Injections, Subcutaneous Pulmonary Embolism / drug therapy* Randomized Controlled Trials as Topic Venous Thrombosis / drug therapy* |
| Chemical | |
Reg. No./Substance:
|
0/Heparin, Low-Molecular-Weight; 9005-49-6/Heparin |
| Comments/Corrections | |
Comment In:
|
ACP J Club. 2005 May-Jun;142(3):71
[PMID:
15862070
]
|
Update In:
|
Cochrane Database Syst Rev. 2010;9:CD001100
[PMID:
20824828
]
|
Update Of:
|
Cochrane Database Syst Rev. 2000;(2):CD001100
[PMID:
10796593
]
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Crisis intervention for people with severe mental illnesses.
Next Document: Psychosocial and psychological interventions for preventing postpartum depression.