PMID- 10647756
OWN - NLM
STAT- MEDLINE
DCOM- 20000210
LR  - 20190812
IS  - 0003-9926 (Print)
IS  - 0003-9926 (Linking)
VI  - 160
IP  - 2
DP  - 2000 Jan 24
TI  - A meta-analysis comparing low-molecular-weight heparins with unfractionated 
      heparin in the treatment of venous thromboembolism: examining some unanswered 
      questions regarding location of treatment, product type, and dosing frequency.
PG  - 181-8
AB  - OBJECTIVES: To compare the efficacy and safety of unfractionated heparin (UFH) 
      and low-molecular-weight heparins (LMWHs) and to examine current controversies in 
      the treatment of venous thromboembolism (VTE) (ie, setting, product type, and 
      frequency of administration). METHODS: Data were abstracted from MEDLINE, HEALTH, 
      previous reviews, personal files, clinical experts, and conference abstracts. 
      Randomized controlled trials of patients diagnosed with acute VTE that compared 
      LMWHs with UFH were included. Independent duplicate assessment was done for 
      methodological quality and data extraction. Data are reported as pooled relative 
      risks (RRs) and 95% confidence intervals (CIs) comparing LMWHs with UFH as 
      determined by the random effects model. RESULTS: Thirteen studies were included. 
      There was no statistically significant difference in risk between UFH and LMWHs 
      for recurrent VTE (RR, 0.85 [95% CI, 0.65-1.12]), pulmonary embolism (RR, 1.02 
      [95% CI, 0.64-1.62]), major bleeding (RR, 0.63 [95% CI, 0.37-1.05]), minor 
      bleeding (RR, 1.18 [95% CI, 0.87-1.61]), and thrombocytopenia (RR, 0.85 [95% CI, 
      0.45-1.62]). There was a statistically significant difference for risk of total 
      mortality (RR, 0.76 [95% CI, 0.59-0.98]) in favor of LMWHs. Inpatient treatment 
      may reduce the risk of major bleeding vs outpatient therapy. Once-daily therapy 
      is as safe and effective as twice-daily therapy when compared indirectly. 
      Different products could not be statistically compared, but qualitative analysis 
      shows that there are no apparent differences in efficacy and safety. CONCLUSIONS: 
      Low-molecular-weight heparins are at least as effective as UFH in preventing 
      recurrent VTE. It is unlikely that LMWHs are superior in the treatment of VTE, 
      but they do show a statistically significant decrease in total mortality. No 
      differences were seen in the development of recurrent VTE dependent on treatment 
      setting. There were no apparent differences between once-daily and twice-daily 
      therapy or among products. Inpatient therapy may be associated with less major 
      bleeding; therefore, if LMWHs are given in the outpatient setting, patients 
      should be rigorously monitored.
FAU - Dolovich, L R
AU  - Dolovich LR
AD  - Centre for Evaluation of Medicines, Department of Pharmacy, St Joseph's Hospital, 
      Hamilton, Ontario, Canada. ldolovic@fhs.csu.mcmaster.ca
FAU - Ginsberg, J S
AU  - Ginsberg JS
FAU - Douketis, J D
AU  - Douketis JD
FAU - Holbrook, A M
AU  - Holbrook AM
FAU - Cheah, G
AU  - Cheah G
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Arch Intern Med
JT  - Archives of internal medicine
JID - 0372440
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/*therapeutic use
MH  - Heparin/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Randomized Controlled Trials as Topic
MH  - Thromboembolism/*drug therapy
EDAT- 2000/01/27 00:00
MHDA- 2000/01/27 00:01
CRDT- 2000/01/27 00:00
PHST- 2000/01/27 00:00 [pubmed]
PHST- 2000/01/27 00:01 [medline]
PHST- 2000/01/27 00:00 [entrez]
AID - 10.1001/archinte.160.2.181 [doi]
PST - ppublish
SO  - Arch Intern Med. 2000 Jan 24;160(2):181-8. doi: 10.1001/archinte.160.2.181.