PMID- 17925410
OWN - NLM
STAT- MEDLINE
DCOM- 20080306
LR  - 20081009
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 133
IP  - 1
DP  - 2008 Jan
TI  - Differences between low-molecular-weight and unfractionated heparin for venous 
      thromboembolism prevention following ischemic stroke: a metaanalysis.
PG  - 149-55
AB  - BACKGROUND: Venous thromboembolism (VTE) remains a major cause of morbidity 
      following stroke. The optimal form of pharmacologic prophylaxis following stroke 
      is unknown. METHODS: We identified randomized trials comparing unfractionated 
      heparin (UFH) to low-molecular-weight heparin (LMWH) for VTE prevention in 
      ischemic stroke patients. We focused on the risk for VTE, pulmonary embolism 
      (PE), bleeding, and mortality as a function of the type of agent used for 
      prophylaxis. Findings were pooled with a random-effects model. RESULTS: We 
      identified three trials including 2,028 patients. Two of the studies were 
      blinded, two studies relied on enoxaparin, while one study utilized certoparin. 
      In two studies, UFH was administered three times a day, while it was administered 
      twice daily in the remaining study. The use of LMWH was associated with a 
      significant risk reduction for any VTE (odds ratio [OR], 0.54; 95% confidence 
      interval [CI], 0.41 to 0.70; p < 0.001). Limiting the analysis to proximal VTEs 
      also indicated that LMWHs were superior (OR with LMWH vs UFH, 0.53; 95% CI, 0.37 
      to 0.75; p < 0.001). LMWH use led to fewer PEs as well (OR, 0.26; 95% CI, 0.07 to 
      0.95; p = 0.042). There were no differences in rates of overall bleeding, 
      intracranial hemorrhage, or mortality based on the type of agent employed. 
      Restricting the analysis to the reports employing enoxaparin did not alter our 
      findings. CONCLUSIONS: The prophylactic use of LMWH compared to UFH following 
      ischemic stroke is associated with a reduction in both VTE and PE. This benefit 
      is not associated with an increased incidence of bleeding. Broader use of LMWH 
      for VTE prevention after ischemic stroke is warranted.
FAU - Shorr, Andrew F
AU  - Shorr AF
AD  - Pulmonary and Critical Care Medicine, Washington Hospital Center, Room 2A-39D, 
      110 Irving St, NW, Washington, DC 20010, USA. andrew.f.shorr@medstar.net
FAU - Jackson, William L
AU  - Jackson WL
FAU - Sherner, John H
AU  - Sherner JH
FAU - Moores, Lisa K
AU  - Moores LK
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
DEP - 20071009
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
SB  - IM
CIN - ACP J Club. 2008 Jul;149(1):8. PMID: 18624376
CIN - Chest. 2008 Aug;134(2):466; author reply 466-7. PMID: 18682471
MH  - Anticoagulants/*therapeutic use
MH  - Brain Ischemia/complications
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Randomized Controlled Trials as Topic
MH  - Stroke/complications
MH  - Venous Thromboembolism/*drug therapy/etiology
EDAT- 2007/10/11 09:00
MHDA- 2008/03/07 09:00
CRDT- 2007/10/11 09:00
PHST- 2007/10/11 09:00 [pubmed]
PHST- 2008/03/07 09:00 [medline]
PHST- 2007/10/11 09:00 [entrez]
AID - S0012-3692(15)48971-8 [pii]
AID - 10.1378/chest.07-1826 [doi]
PST - ppublish
SO  - Chest. 2008 Jan;133(1):149-55. doi: 10.1378/chest.07-1826. Epub 2007 Oct 9.