PMID- 17296655
OWN - NLM
STAT- MEDLINE
DCOM- 20070316
LR  - 20070213
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 131
IP  - 2
DP  - 2007 Feb
TI  - Twice vs three times daily heparin dosing for thromboembolism prophylaxis in the 
      general medical population: A metaanalysis.
PG  - 507-16
AB  - OBJECTIVES: Prophylaxis with unfractionated heparin (UFH) has been proven to 
      reduce rates of venous thromboembolism (VTE) in hospitalized medical patients. 
      While twice-daily (BID) and three-times-daily (TID) dosing regimens have been 
      studied, the two have never been directly compared. We performed a metaanalysis 
      to assess whether TID is superior to BID dosing in the prevention of VTE. 
      METHODS: Medline, EMBASE, and Cochrane Controlled Trials Register from 1966 
      through December 2004 were searched for randomized trials comparing 
      subcutaneously dosed UHF (either BID or TID) with placebo or control for VTE 
      prophylaxis in medical patient populations. Two reviewers independently rated 
      study quality on the basis of predetermined criteria. Data were extracted on 
      patient age, hospital setting, comorbidities, VTE rates, and bleeding 
      complications. RESULTS: Twelve studies were identified; 7,978 patients (1,664 
      patients in the TID arm, and 6,314 patients in the BID arm) were included. After 
      adjustment for baseline risk, there was no difference in the overall rate (per 
      1,000 patient-days) of VTE (BID, 5.4; vs TID, 3.5; p = 0.87). TID heparin showed 
      a trend toward a decrease in pulmonary embolism (PE) [BID, 1.5; vs TID, 0.5; p = 
      0.09] and in proximal DVT and PE (BID, 2.3; vs TID, 0.9; p = 0.05). The risk for 
      major bleeding was significantly increased with TID heparin (BID, 0.35; vs TID, 
      0.96; p < 0.001). CONCLUSIONS: BID heparin dosing causes fewer major bleeding 
      episodes, while TID dosing appears to offer somewhat better efficacy in 
      preventing clinically relevant VTE events. Practitioners should use underlying 
      risk for VTE and bleeding to individualize pharmacologic prevention.
FAU - King, Christopher S
AU  - King CS
AD  - Department of Medicine, Walter Reed Army Medical Center, 6900 Georgia Ave NW, 
      Washington, DC 20307, USA.
FAU - Holley, Aaron B
AU  - Holley AB
FAU - Jackson, Jeffrey L
AU  - Jackson JL
FAU - Shorr, Andrew F
AU  - Shorr AF
FAU - Moores, Lisa K
AU  - Moores LK
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Fibrinolytic Agents)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Drug Administration Schedule
MH  - Fibrinolytic Agents/*administration & dosage/adverse effects
MH  - Heparin/*administration & dosage/adverse effects
MH  - Hospitalization
MH  - Humans
MH  - Thromboembolism/*prevention & control
MH  - Treatment Outcome
EDAT- 2007/02/14 09:00
MHDA- 2007/03/17 09:00
CRDT- 2007/02/14 09:00
PHST- 2007/02/14 09:00 [pubmed]
PHST- 2007/03/17 09:00 [medline]
PHST- 2007/02/14 09:00 [entrez]
AID - S0012-3692(15)48338-2 [pii]
AID - 10.1378/chest.06-1861 [doi]
PST - ppublish
SO  - Chest. 2007 Feb;131(2):507-16. doi: 10.1378/chest.06-1861.