BACKGROUND: Previous meta-analyses comparing low molecular weight heparin (LMWH) and unfractionated heparin for thrombosis prophylaxis after surgical interventions need updating. METHODS: This is a publication-based meta-analysis of 36 double-blind studies including 16583 patients. Main outcome measures are incidence of deep vein thrombosis (efficacy) and wound haematoma (safety). RESULTS: In general surgery there is no increased efficacy in favour of LMWH (odds ratio (OR) 0.88, 95 per cent confidence interval (c.i.) 0.60-1.30) but there exists a higher incidence of bleeding complications (OR 1.47, 95 per cent c.i. 1.07-2.01). Low-dose LMWH is equally efficacious (OR 1.03, 95 per cent c.i. 0.85-1.26) but safer than unfractionated heparin (OR 0.68, 95 per cent c.i. 0.56-0.82). In orthopaedic surgery there is a trend towards an increased efficacy for LMWH (OR 0.83, 95 per cent c.i. 0.68-1.02) with equivalent safety (OR 0.96, 95 per cent c.i. 0.68-1.36). CONCLUSION: A superiority of LMWH is suggested but heterogeneity might make generalizability to future patients questionable. A meta-analysis on individual patient data should be the next step before randomizing additional patients in future trials.
BACKGROUND: Previous meta-analyses comparing low molecular weight heparin (LMWH) and unfractionated heparin for thrombosis prophylaxis after surgical interventions need updating. METHODS: This is a publication-based meta-analysis of 36 double-blind studies including 16583 patients. Main outcome measures are incidence of deep vein thrombosis (efficacy) and wound haematoma (safety). RESULTS: In general surgery there is no increased efficacy in favour of LMWH (odds ratio (OR) 0.88, 95 per cent confidence interval (c.i.) 0.60-1.30) but there exists a higher incidence of bleeding complications (OR 1.47, 95 per cent c.i. 1.07-2.01). Low-dose LMWH is equally efficacious (OR 1.03, 95 per cent c.i. 0.85-1.26) but safer than unfractionated heparin (OR 0.68, 95 per cent c.i. 0.56-0.82). In orthopaedic surgery there is a trend towards an increased efficacy for LMWH (OR 0.83, 95 per cent c.i. 0.68-1.02) with equivalent safety (OR 0.96, 95 per cent c.i. 0.68-1.36). CONCLUSION: A superiority of LMWH is suggested but heterogeneity might make generalizability to future patients questionable. A meta-analysis on individual patient data should be the next step before randomizing additional patients in future trials.
Authors: R S McLeod; W H Geerts; K W Sniderman; C Greenwood; R C Gregoire; B M Taylor; R E Silverman; K G Atkinson; M Burnstein; J C Marshall; C J Burul; D R Anderson; T Ross; S R Wilson; P Barton Journal: Ann Surg Date: 2001-03 Impact factor: 12.969
Authors: Z Tazi Mezalek; C Nejjari; L Essadouni; M Samkaoui; K Serraj; W Ammouri; N Kanjaa; Z Belkhadir; B Housni; M Awab; M Faroudy; W Bono; S Kabbaj; M Akkaoui; M Barakat; R Rifai; H Charaf; A Aziz; Y Elachhab; A Azzouzi Journal: J Thromb Thrombolysis Date: 2018-07 Impact factor: 2.300
Authors: Kristoffer Lassen; Marielle M E Coolsen; Karem Slim; Francesco Carli; José E de Aguilar-Nascimento; Markus Schäfer; Rowan W Parks; Kenneth C H Fearon; Dileep N Lobo; Nicolas Demartines; Marco Braga; Olle Ljungqvist; Cornelis H C Dejong Journal: World J Surg Date: 2013-02 Impact factor: 3.352