PMID- 19588346
OWN - NLM
STAT- MEDLINE
DCOM- 20090814
LR  - 20220321
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 3
DP  - 2009 Jul 8
TI  - Heparin for the prevention of venous thromboembolism in general medical patients 
      (excluding stroke and myocardial infarction).
PG  - CD003747
LID - 10.1002/14651858.CD003747.pub2 [doi]
AB  - BACKGROUND: Venous thromboembolic disease has been extensively studied in 
      surgical patients. The benefit of thromboprophylaxis is now generally accepted, 
      but it is medical patients who make up the greater proportion of the hospital 
      population. Medical patients differ from surgical patients with regard to their 
      health and the pathogenesis of thromboembolism and the impact that preventative 
      measures can have. The extensive experience from thromboprophylaxis studies in 
      surgical patients is therefore not necessarily applicable to non-surgical 
      patients. OBJECTIVES: To determine the effectiveness and safety of heparin 
      thromboprophylaxis in general medical patients. SEARCH STRATEGY: The Cochrane 
      Peripheral Vascular Diseases Group searched their Specialised Register (last 
      searched 24 April 2009) and the Cochrane Central Register of Controlled Trials in 
      The Cochrane Library (last searched Issue 2, 2009)We handsearched meeting 
      abstracts, and consulted with colleagues and investigators as well as the 
      manufacturers of the various LMWH preparations to identify unpublished or missed 
      studies. SELECTION CRITERIA: Randomised controlled trials comparing 
      unfractionated heparin (UFH) or low molecular weight heparin (LMWH) with placebo 
      or no treatment, or comparing UFH with LMWH. DATA COLLECTION AND ANALYSIS: One 
      author identified possible trials, and the other author confirmed eligibility for 
      inclusion in the review. Both authors extracted the data. Disagreements were 
      resolved by discussion. We performed the meta-analysis as a fixed-effect model 
      with relative risks. MAIN RESULTS: A significant risk reduction in deep vein 
      thrombosis (DVT) by 60% (relative risk (RR) 0.40; 95% confidence interval CI 0.31 
      to 0.53; P < 0.00001) and pulmonary embolism (PE) by 42% (RR 0.58; 95% CI 0.43 to 
      0.80; P = 0.0007) was observed with heparin compared with placebo or no 
      treatment. However, heparin resulted in a significant increase in major 
      haemorrhage (RR 2.18; 95% CI 1.28 to 3.72; P = 0.004) and minor haemorrhage (RR 
      1.74; 95% CI 1.26 to 2.41; P = 0.0008). There was no statistically significant 
      difference in efficacy between LMWH and UFH. There was a statistically 
      significant 72% risk reduction in major bleeding when LMWH was compared with UFH 
      (RR 0.28; 95% CI 0.10 to 0.78; P = 0.02). AUTHORS' CONCLUSIONS: The data from 
      this review support the use of heparin thromboprophylaixs in medical patients 
      presenting with an acute medical illness. Although the analysis found no 
      significant difference in efficacy between LMWH and UFH, it did note differences 
      in the incidence of DVT and clinical PE with a significantly reduced risk of 
      bleeding in favour of LMWH.
FAU - Alikhan, Raza
AU  - Alikhan R
AD  - Oxford Haemophilia and Thrombosis Centre, Churchill Hospital, Old Road, 
      Headington, Oxford, UK, OX3 7LJ.
FAU - Cohen, Alexander T
AU  - Cohen AT
LA  - eng
GR  - CZB/4/609/CSO_/Chief Scientist Office/United Kingdom
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20090708
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
UIN - Cochrane Database Syst Rev. 2010;(2):CD003747. PMID: 20166070
MH  - Acute Disease
MH  - Anticoagulants/*therapeutic use
MH  - Heparin/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - Pulmonary Embolism/*prevention & control
MH  - Randomized Controlled Trials as Topic
MH  - Venous Thromboembolism/*prevention & control
MH  - Venous Thrombosis/prevention & control
RF  - 45
EDAT- 2009/07/10 09:00
MHDA- 2009/08/15 09:00
CRDT- 2009/07/10 09:00
PHST- 2009/07/10 09:00 [entrez]
PHST- 2009/07/10 09:00 [pubmed]
PHST- 2009/08/15 09:00 [medline]
AID - 10.1002/14651858.CD003747.pub2 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2009 Jul 8;(3):CD003747. doi: 
      10.1002/14651858.CD003747.pub2.