PMID- 12941030
OWN - NLM
STAT- MEDLINE
DCOM- 20040519
LR  - 20230829
IS  - 1538-7933 (Print)
IS  - 1538-7836 (Linking)
VI  - 1
IP  - 9
DP  - 2003 Sep
TI  - Low-molecular-weight heparin for the long-term treatment of symptomatic venous 
      thromboembolism: meta-analysis of the randomized comparisons with oral 
      anticoagulants.
PG  - 1906-13
AB  - BACKGROUND: The management of venous thromboembolism (VTE) requires an initial 
      treatment with unfractionated heparin (UFH) or low-molecular-weight heparin 
      (LMWH), followed by oral anticoagulants (OA) for at least 3 months. OA treatment 
      however, requires laboratory monitoring of anticoagulation, carries a definite 
      risk of bleeding, and may be contraindicated in some patients. As an alternative 
      to vitamin K antagonists, subcutaneous LMWH has been proposed and evaluated in 
      randomized clinical trials, but they are all small studies that lack the power to 
      establish if these two treatment modalities are equivalent in efficacy or safety. 
      OBJECTIVES: The objective of this review was to evaluate the efficacy (VTE 
      recurrence) and safety (bleeds and deaths) of long-term treatment of VTE with 
      LMWH compared with OA. A secondary endpoint was to evaluate the effect of LMWH on 
      cancer mortality. METHODS: Computerized searches of MedLine and EmBase were 
      performed. In addition, randomized clinical trials were located through personal 
      communication with colleagues, and through the manual scanning of meeting 
      proceedings and reference lists of relevant studies. When necessary, the authors 
      of the selected papers were called to obtain additional information. Two 
      reviewers (AI and FG) reviewed and extracted data independently using a standard 
      form. The primary analysis was performed for efficacy and safety endpoints on an 
      intention-to-treat basis for the study period of randomized treatment. A 
      meta-regression analysis was used to investigate the relationship between daily 
      dose and clinical outcome. RESULTS: Seven studies that fulfillled our predefined 
      criteria were identified, for a total of 1379 patients. When all studies were 
      combined, a statistically non-significant reduction in the risk of VTE (OR 0.66; 
      95% confidence interval [CI] 0.41, 1.07) and in the risk of major bleeding (OR 
      0.45; 95% CI 0.18, 1.11) in favor of LMWH treatment was found. No difference in 
      total mortality (OR 1.19; 95% CI 0.78, 1.83) or in cancer-related mortality was 
      observed between the LMWH and the OA treatment. CONCLUSIONS: The results of this 
      meta-analysis indicate that a 3-month course of LMWH is as effective and safe as 
      a corresponding period of OA treatment, and may thus be considered as a valuable 
      alternative option for patients in whom OA treatment appears contraindicated or 
      problematic.
FAU - Iorio, A
AU  - Iorio A
AD  - Sezione de Medicina Interna e Cardiovasculare, Universita di Perugia, Perugia, 
      Italy. iorioa@unigp.it
FAU - Guercini, F
AU  - Guercini F
FAU - Pini, M
AU  - Pini M
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PL  - England
TA  - J Thromb Haemost
JT  - Journal of thrombosis and haemostasis : JTH
JID - 101170508
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
MH  - Anticoagulants/therapeutic use
MH  - Hemorrhage/chemically induced
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Neoplasms/complications/drug therapy/mortality
MH  - Randomized Controlled Trials as Topic/*statistics & numerical data
MH  - Recurrence
MH  - Thromboembolism/*drug therapy/epidemiology/mortality
MH  - Treatment Outcome
MH  - Venous Thrombosis/*drug therapy/epidemiology/mortality
EDAT- 2003/08/28 05:00
MHDA- 2004/05/20 05:00
CRDT- 2003/08/28 05:00
PHST- 2003/08/28 05:00 [pubmed]
PHST- 2004/05/20 05:00 [medline]
PHST- 2003/08/28 05:00 [entrez]
AID - S1538-7836(22)15347-X [pii]
AID - 10.1046/j.1538-7836.2003.00364.x [doi]
PST - ppublish
SO  - J Thromb Haemost. 2003 Sep;1(9):1906-13. doi: 10.1046/j.1538-7836.2003.00364.x.