PMID- 15495007
OWN - NLM
STAT- MEDLINE
DCOM- 20050323
LR  - 20220317
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 4
DP  - 2004 Oct 18
TI  - Fixed dose subcutaneous low molecular weight heparins versus adjusted dose 
      unfractionated heparin for venous thromboembolism.
PG  - CD001100
AB  - 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.
FAU - van Dongen, C J J
AU  - van Dongen CJ
FAU - van den Belt, A G M
AU  - van den Belt AG
FAU - Prins, M H
AU  - Prins MH
FAU - Lensing, A W A
AU  - Lensing AW
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20041018
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
UOF - Cochrane Database Syst Rev. 2000;(2):CD001100. PMID: 10796593
CIN - ACP J Club. 2005 May-Jun;142(3):71. PMID: 15862070
UIN - Cochrane Database Syst Rev. 2010;(9):CD001100. PMID: 20824828
MH  - Heparin/administration & dosage/adverse effects
MH  - Heparin, Low-Molecular-Weight/*administration & dosage/adverse effects
MH  - Humans
MH  - Injections, Subcutaneous
MH  - Pulmonary Embolism/*drug therapy
MH  - Randomized Controlled Trials as Topic
MH  - Venous Thrombosis/*drug therapy
RF  - 58
EDAT- 2004/10/21 09:00
MHDA- 2005/03/24 09:00
CRDT- 2004/10/21 09:00
PHST- 2004/10/21 09:00 [pubmed]
PHST- 2005/03/24 09:00 [medline]
PHST- 2004/10/21 09:00 [entrez]
AID - 10.1002/14651858.CD001100.pub2 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2004 Oct 18;(4):CD001100. doi: 
      10.1002/14651858.CD001100.pub2.