PMID- 20824828
OWN - NLM
STAT- MEDLINE
DCOM- 20101018
LR  - 20211028
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 9
DP  - 2010 Sep 8
TI  - Fixed dose subcutaneous low molecular weight heparins versus adjusted dose 
      unfractionated heparin for venous thromboembolism.
PG  - CD001100
LID - 10.1002/14651858.CD001100.pub3 [doi]
AB  - BACKGROUND: Low molecular weight heparins (LMWHs) have been shown to be effective 
      and safe in preventing venous thromboembolism (VTE). They may also be effective 
      for the initial treatment of VTE. This is an update of a Cochrane review first 
      published in 1999 and previously updated in 2004. OBJECTIVES: To determine the 
      effect of LMWH compared with unfractionated heparin (UFH) for the initial 
      treatment of VTE. SEARCH STRATEGY: Trials were identified by searching the 
      Cochrane Peripheral Vascular Diseases Group Specialised Register and CENTRAL (The 
      Cochrane Library). Colleagues and pharmaceutical companies were contacted for 
      additional information. SELECTION CRITERIA: Randomised controlled trials 
      comparing fixed dose subcutaneous LMWH with adjusted dose intravenous or 
      subcutaneous UFH in people with VTE. DATA COLLECTION AND ANALYSIS: Two review 
      authors assessed trials for inclusion and quality, and extracted data 
      independently. MAIN RESULTS: Twenty-three studies were included (n = 9587). 
      Thrombotic complications occurred in 3.6% of participants treated with LMWH 
      compared with 5.3% treated with UFH (odds ratio (OR) 0.70; 95% confidence 
      interval (CI) 0.57 to 0.85). Thrombus size was reduced in 53% of participants 
      treated with LMWH and 45% treated with UFH (OR 0.69; 95% CI 0.59 to 0.81). Major 
      haemorrhages occurred in 1.1% of participants treated with LMWH compared with 
      1.9% treated with UFH (OR 0.58; 95% CI 0.40 to 0.83). In 19 trials, 4.3% of 
      participants treated with LMWH died compared with 5.8% of participants treated 
      with UFH (OR 0.77; 95% CI 0.63 to 0.93).Nine studies (n = 4451) examined proximal 
      thrombosis, 2192 participants were treated with LMWH and 2259 with UFH. Subgroup 
      analysis showed statistically significant reductions favouring LMWH in thrombotic 
      complications and major haemorrhage. By end of follow up, 80 (3.6%) participants 
      treated with LMWH had thrombotic complications compared with 143 (6.3%) treated 
      with UFH (OR 0.57; 95% CI 0.44 to 0.75). Major haemorrhages occurred in 18 (1.0%) 
      participants treated with LMWH compared with 37 (2.1%) treated with UFH (OR 0.50; 
      95% CI 0.29 to 0.85). Nine studies showed a statistically significant reduction 
      in mortality favouring LMWH. By the end of follow up, 3.3% (70/2094) of 
      participants treated with LMWH had died and 5.3% (110/2063) treated with UFH. 
      AUTHORS' CONCLUSIONS: Fixed dose LMWH is more effective and safer than adjusted 
      dose UFH for the initial treatment of VTE. Compared to UFH, LMWH significantly 
      reduced the incidence of thrombotic complications, the occurrence of major 
      haemorrhage during initial treatment and overall mortality at follow up.
FAU - Erkens, Petra Mg
AU  - Erkens PM
AD  - Department of General Practice, University of Maastricht, Debyeplein 1, 
      Maastricht, Netherlands, 6229 HA.
FAU - Prins, Martin H
AU  - Prins MH
LA  - eng
GR  - CZB/4/788/CSO_/Chief Scientist Office/United Kingdom
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20100908
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
UOF - Cochrane Database Syst Rev. 2004;(4):CD001100. PMID: 15495007
UIN - Cochrane Database Syst Rev. 2017 Feb 09;2:CD001100. PMID: 28182249
MH  - Hemorrhage/chemically induced
MH  - Heparin/administration & dosage/adverse effects
MH  - Heparin, Low-Molecular-Weight/*administration & dosage/adverse effects
MH  - Humans
MH  - Injections, Subcutaneous
MH  - Pulmonary Embolism/*drug therapy/mortality
MH  - Randomized Controlled Trials as Topic
MH  - Venous Thrombosis/*drug therapy/mortality
RF  - 62
EDAT- 2010/09/09 06:00
MHDA- 2010/10/19 06:00
CRDT- 2010/09/09 06:00
PHST- 2010/09/09 06:00 [entrez]
PHST- 2010/09/09 06:00 [pubmed]
PHST- 2010/10/19 06:00 [medline]
AID - 10.1002/14651858.CD001100.pub3 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2010 Sep 8;(9):CD001100. doi: 
      10.1002/14651858.CD001100.pub3.