PMID- 17646601
OWN - NLM
STAT- MEDLINE
DCOM- 20070828
LR  - 20191210
IS  - 0003-9926 (Print)
IS  - 0003-9926 (Linking)
VI  - 167
IP  - 14
DP  - 2007 Jul 23
TI  - Pharmacological venous thromboembolism prophylaxis in hospitalized medical 
      patients: a meta-analysis of randomized controlled trials.
PG  - 1476-86
AB  - BACKGROUND: There is uncertainty regarding which pharmacological agents most 
      effectively prevent venous thromboembolism in hospitalized medical patients. We 
      therefore performed a meta-analysis to determine this. METHODS: MEDLINE, EMBASE, 
      and the Cochrane Central Register of Controlled Trials were searched from 1950, 
      1966, and 1800, respectively, through June 30, 2006, for randomized controlled 
      trials that involved medical patients comparing unfractionated heparin (UFH) or 
      low-molecular-weight heparin or heparinoid (LMWH) with a control, LMWH with UFH, 
      or selective factor Xa inhibitors with a comparator. Study selection, validity 
      assessment, and data abstraction were performed by 2 independent reviewers (L.W. 
      and S.W.). Data synthesis was undertaken by 1 blinded investigator (S.J.H.). 
      RESULTS: Thirty-six studies were included. Compared with the control, UFH was 
      associated with a reduced risk of deep venous thrombosis (DVT) (risk ratio [RR], 
      0.33; 95% confidence interval [CI], 0.26-0.42) and pulmonary embolism (RR, 0.64; 
      95% CI, 0.50-0.82), as was LMWH (RR, 0.56; 95% CI, 0.45-0.70; and RR, 0.37; 95% 
      CI, 0.21-0.64, respectively). A UFH dosage of 5000 U 3 times daily was more 
      effective in preventing DVT than a UFH dosage of 5000 U twice daily when compared 
      with the control (RR, 0.27; 95% CI, 0.20-0.36; vs RR, 0.52; 95% CI, 0.28-0.96). 
      Neither UFH nor LMWH reduced mortality. When directly compared with UFH, LMWH was 
      associated with a lower risk of DVT (RR, 0.68; 95% CI, 0.52-0.88) and injection 
      site hematoma (RR, 0.47; 95% CI, 0.36-0.62), but no difference was seen between 
      the 2 agents in the risk of bleeding or thrombocytopenia. CONCLUSIONS: Both UFH 
      and LMWH reduce venous thromboembolic risk in hospitalized medical patients, but 
      neither agent alters mortality. When directly compared, LMWH is more effective in 
      preventing DVT.
FAU - Wein, Lironne
AU  - Wein L
AD  - National Health and Medical Research Council Centre of Clinical Research 
      Excellence in Therapeutics, Department of Epidemiology and Preventive Medicine, 
      Monash University, Alfred Medical Research and Education Precinct, Melbourne, 
      Victoria 3004, Australia.
FAU - Wein, Sara
AU  - Wein S
FAU - Haas, Steven Joseph
AU  - Haas SJ
FAU - Shaw, James
AU  - Shaw J
FAU - Krum, Henry
AU  - Krum H
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Arch Intern Med
JT  - Archives of internal medicine
JID - 0372440
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
CIN - Arch Intern Med. 2007 Jul 23;167(14):1451-2. PMID: 17646597
CIN - J Fam Pract. 2007 Oct;56(10):796. PMID: 17912782
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Heparin/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Inpatients
MH  - Outcome Assessment, Health Care
MH  - Pulmonary Embolism/prevention & control
MH  - Venous Thrombosis/*prevention & control
EDAT- 2007/07/25 09:00
MHDA- 2007/08/29 09:00
CRDT- 2007/07/25 09:00
PHST- 2007/07/25 09:00 [pubmed]
PHST- 2007/08/29 09:00 [medline]
PHST- 2007/07/25 09:00 [entrez]
AID - 167/14/1476 [pii]
AID - 10.1001/archinte.167.14.1476 [doi]
PST - ppublish
SO  - Arch Intern Med. 2007 Jul 23;167(14):1476-86. doi: 10.1001/archinte.167.14.1476.