PMID- 10695506
OWN - NLM
STAT- MEDLINE
DCOM- 20000322
LR  - 20181130
IS  - 0340-6245 (Print)
IS  - 0340-6245 (Linking)
VI  - 82 Suppl 1
DP  - 1999 Sep
TI  - Low-molecular weight heparins in venous and arterial thrombotic disease.
PG  - 139-47
AB  - INTRODUCTION: Since the introduction of low-molecular-weight heparins (LMWHs) in 
      the early 1980's, the use of these compounds has been extensively investigated as 
      a substitute for unfractionated heparin (UFH) in patients with venous and 
      arterial thrombotic diseases. LMWHs have several advantages as compared to UFH, 
      such as the subcutaneous route of administration, the predictable anticoagulant 
      response and the lack of the need for laboratory monitoring. The present 
      systematic review evaluates randomised clinical trials which investigated the 
      efficacy and safety of LMWH in the acute treatment of venous thromboembolism, 
      myocardial infarction, unstable coronary syndromes and ischemic stroke. METHODS: 
      A computerised and manual search was performed to identify all relevant clinical 
      trials. All randomised studies, with an a priori defined study population, 
      clinical outcome measurement and adequate follow-up, were reviewed by two 
      independent assessors. Whenever possible a common effect estimate of the included 
      studies was calculated. RESULTS: Thirteen studies in approximately 4000 patients 
      with acute venous thromboembolism revealed an odds ratio for the 3-month 
      recurrent thromboembolism rate and major bleeding complications during exposure 
      of 0.77 (C.I. 0.57-1.04) and 0.61 (C.I. 0.39-0.95), respectively, in favour of 
      LMWH as compared to UFH. In patients with acute myocardial infarction, one study 
      suggested a reduction in the incidence of reinfarction and cardiac death in LMWH 
      recipients compared to UFH, while a placebo-controlled study revealed no 
      beneficial effect of LMWH on these outcomes. In six studies including over 7000 
      patients with acute unstable coronary syndromes, there was an odds ratio for 
      recurrent angina, myocardial infarction, urgent revascularisation and major 
      bleedings of 0.88 (C.I. 0.76-1.01), 0.84 (C.I. 0.69-1.01), 0.83 (C.I. 0.70-0.99), 
      1.09 (C.I. 0.70-1.70), respectively, in favour of LMWH compared to UFH. The three 
      studies comparing LMWH treatment with placebo in approximately 1000 patients with 
      acute ischemic stroke revealed an odds ratio for the 10-day recurrent stroke, 
      death or disability after 3 months and major bleeding complications of 0.68 (C.I. 
      0.41-1.13), 0.94 (C.I. 0.78-1.15), 2.92 (C.I. 1.88-4.55), respectively. 
      CONCLUSION: Fixed-dose subcutaneous LMWH appears to be a safe and effective 
      alternative for dose-adjusted intravenous heparin in the treatment of patients 
      with acute venous thrombotic disease as well as in patients with acute unstable 
      coronary syndromes. The effectiveness of LMWH in patients with acute myocardial 
      infarction remains unclear. There seems to be no beneficial effect of LMWH 
      treatment as compared to placebo in patients with acute ischemic stroke, while 
      the risk of major bleeding was clearly increased.
FAU - Bijsterveld, N R
AU  - Bijsterveld NR
AD  - Department of Vascular Medicine, University of Amsterdam, The Netherlands.
FAU - Hettiarachchi, R
AU  - Hettiarachchi R
FAU - Peters, R
AU  - Peters R
FAU - Prins, M H
AU  - Prins MH
FAU - Levi, M
AU  - Levi M
FAU - Buller, H R
AU  - Buller HR
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
PL  - Germany
TA  - Thromb Haemost
JT  - Thrombosis and haemostasis
JID - 7608063
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Fibrinolytic Agents/*administration & dosage
MH  - Heparin, Low-Molecular-Weight/*administration & dosage
MH  - Humans
MH  - Injections, Subcutaneous
MH  - Randomized Controlled Trials as Topic
MH  - Thrombosis/*drug therapy
MH  - Treatment Outcome
MH  - Venous Thrombosis/*drug therapy
EDAT- 2000/03/01 09:00
MHDA- 2000/03/25 09:00
CRDT- 2000/03/01 09:00
PHST- 2000/03/01 09:00 [pubmed]
PHST- 2000/03/25 09:00 [medline]
PHST- 2000/03/01 09:00 [entrez]
PST - ppublish
SO  - Thromb Haemost. 1999 Sep;82 Suppl 1:139-47.