PMID- 15609788
OWN - NLM
STAT- MEDLINE
DCOM- 20050113
LR  - 20190922
IS  - 0266-4623 (Print)
IS  - 0266-4623 (Linking)
VI  - 20
IP  - 4
DP  - 2004 Fall
TI  - Major bleeding rates after prophylaxis against venous thromboembolism: systematic 
      review, meta-analysis, and cost implications.
PG  - 405-14
AB  - OBJECTIVES: The frequency and consequences of major bleeding associated with 
      anticoagulant prophylaxis for prevention of venous thromboembolism is examined. 
      METHODS: We conducted a systematic review and meta-analysis of controlled trials 
      that reported rates of major bleeding after pharmaceutical thromboprophylaxis in 
      patients undergoing major orthopedic surgery. Thromboprophylactic agents were 
      divided into four groups: warfarin/other coumarin derivatives (WARF), 
      unfractionated heparin (UFH), low molecular weight heparin (LMWH), and 
      pentasaccharide (PS). Meta-analysis was conducted comparing LMWH with each of 
      WARF, UFH, and PS. The frequency of re-operation due to major bleeding was 
      reviewed and combined with published costs to estimate the mean cost of managing 
      major bleeding events in these patients. RESULTS: Twenty-one studies including 
      20,523 patients met inclusion criteria for the meta-analysis. No evidence of 
      significant between-trial heterogeneity in risk ratios was found. Combined (fixed 
      effects) relative risks (RR) of major bleeding compared with LMWH were WARF--RR 
      0.59 (95 percent confidence interval [CI], 0.44-0.80); UFH--RR 1.52 (95 percent 
      CI, 1.04-2.23); PS--RR 1.52 (95 percent CI, 1.11-2.09). Seventy-one studies 
      including 32,433 patients were included in the review of consequences of major 
      bleeding. We estimated that the average cost of major bleeding is 113 dollars per 
      patient receiving thromboprophylaxis. CONCLUSIONS: LMWH results in fewer major 
      bleeding episodes than UFH and PS but more than WARF. These events are costly and 
      clinically important.
FAU - Muntz, James
AU  - Muntz J
AD  - Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA. 
      jmuntz@tmh.tmc.edu
FAU - Scott, David A
AU  - Scott DA
FAU - Lloyd, Adam
AU  - Lloyd A
FAU - Egger, Matthias
AU  - Egger M
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
PL  - England
TA  - Int J Technol Assess Health Care
JT  - International journal of technology assessment in health care
JID - 8508113
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Anticoagulants/*adverse effects/*economics
MH  - Costs and Cost Analysis
MH  - Hemorrhage/*chemically induced/*economics
MH  - Humans
MH  - Orthopedic Procedures/adverse effects/economics
MH  - Reoperation/economics
MH  - Thromboembolism/*prevention & control
MH  - Venous Thrombosis/*prevention & control
RF  - 101
EDAT- 2004/12/22 09:00
MHDA- 2005/01/14 09:00
CRDT- 2004/12/22 09:00
PHST- 2004/12/22 09:00 [pubmed]
PHST- 2005/01/14 09:00 [medline]
PHST- 2004/12/22 09:00 [entrez]
AID - 10.1017/s026646230400128x [doi]
PST - ppublish
SO  - Int J Technol Assess Health Care. 2004 Fall;20(4):405-14. doi: 
      10.1017/s026646230400128x.