PMID- 20177819
OWN - NLM
STAT- MEDLINE
DCOM- 20101112
LR  - 20211020
IS  - 1970-9366 (Electronic)
IS  - 1828-0447 (Linking)
VI  - 5
IP  - 4
DP  - 2010 Aug
TI  - Venous thromboembolism prophylaxis with unfractionated heparin in the 
      hospitalized medical patient: the case for thrice daily over twice daily dosing.
PG  - 299-306
LID - 10.1007/s11739-010-0359-8 [doi]
AB  - For venous thromboembolism (VTE) prevention in the hospitalized medical patient, 
      no head-to-head trials have been performed of unfractionated heparin (UFH) 5,000 
      U subcutaneously thrice (i.e. q8 h or TID) daily versus twice daily (q12 h or 
      BID). Several meta-analyses have been undertaken in attempts to determine whether 
      one regimen may be more beneficial for safety and efficacy. Currently, not all 
      international guidelines include a recommended frequency for UFH. Delineation of 
      this frequency may be helpful to the practicing clinician. Primary studies (with 
      a modified Jadad score of >or=6 to demonstrate a stronger study design) that 
      compared low molecular weight heparin (LMWH) and UFH, and UFH and placebo were 
      evaluated. Meta-analyses evaluating safety and efficacy of LMWH versus UFH, or 
      TID UFH versus BID UFH were also evaluated. Although BID UFH shows some efficacy 
      in one primary study, it is no more beneficial than no prophylaxis in another 
      study. LMWH appears to be more efficacious than BID UFH, but comparable in safety 
      and efficacy to TID UFH. Meta-analytic data demonstrates that BID UFH may have 
      some reduction in deep vein thrombosis. Meta-analytic data also suggests that TID 
      UFH is more efficacious than BID UFH at the cost of more major bleeding. The 
      medical patient with risk factors for the development of VTE appears to be at 
      moderate to high risk. International guidelines for VTE prevention should 
      incorporate a frequency for UFH to guide use. TID UFH is superior in efficacy to 
      BID UFH even when taking into consideration the increased rate of major bleeds. 
      Newly published risk-assessment models may be beneficial in determining which 
      patients would best benefit from BID UFH or TID UFH.
FAU - Mahan, Charles E
AU  - Mahan CE
AD  - Cardinal Health Pharmacy Solutions, Lovelace Medical Center, Lovelace 
      Rehabilitation Hospital, Lovelace Health Systems, 601 Dr. Martin Luther King Jr. 
      Ave. NE, Albuquerque, NM, 87102, USA. charles.mahan@lovelace.com
FAU - Pini, Mario
AU  - Pini M
FAU - Spyropoulos, Alex C
AU  - Spyropoulos AC
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20100223
PL  - Italy
TA  - Intern Emerg Med
JT  - Internal and emergency medicine
JID - 101263418
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 129480-74-6 (ITF 300)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/administration & dosage/therapeutic use
MH  - Heparin/administration & dosage/*analogs & derivatives/therapeutic use
MH  - Heparin, Low-Molecular-Weight/administration & dosage/therapeutic use
MH  - *Hospitalization
MH  - Humans
MH  - Venous Thromboembolism/*prevention & control
EDAT- 2010/02/24 06:00
MHDA- 2010/11/13 06:00
CRDT- 2010/02/24 06:00
PHST- 2009/10/28 00:00 [received]
PHST- 2010/01/12 00:00 [accepted]
PHST- 2010/02/24 06:00 [entrez]
PHST- 2010/02/24 06:00 [pubmed]
PHST- 2010/11/13 06:00 [medline]
AID - 10.1007/s11739-010-0359-8 [doi]
PST - ppublish
SO  - Intern Emerg Med. 2010 Aug;5(4):299-306. doi: 10.1007/s11739-010-0359-8. Epub 
      2010 Feb 23.