PMID- 21349929
OWN - NLM
STAT- MEDLINE
DCOM- 20111013
LR  - 20170521
IS  - 1931-3543 (Electronic)
IS  - 0012-3692 (Linking)
VI  - 140
IP  - 2
DP  - 2011 Aug
TI  - Dosing frequency of unfractionated heparin thromboprophylaxis: a meta-analysis.
PG  - 374-381
LID - S0012-3692(11)60411-X [pii]
LID - 10.1378/chest.10-3084 [doi]
AB  - BACKGROUND: In medical patients, it is unclear whether thromboprophylaxis with 
      low-dose unfractionated heparin (UFH) should be administered bid or tid. METHODS: 
      This study was a mixed-treatment comparison meta-analysis of randomized control 
      trials that enrolled hospitalized nonsurgical patients at risk for VTE and 
      compared UFH bid, UFH tid, or low-molecular-weight heparin (LMWH) to one another 
      or to an inactive control subject. DVT, pulmonary embolism (PE), major bleeding, 
      and death were measured. A Bayesian framework using a random-effects model was 
      applied. RESULTS: Sixteen trials with moderate methodologic quality enrolling 
      27,667 patients contributed to this analysis. The relative risk and 95% credible 
      intervals comparing UFH tid to UFH bid for DVT, PE, death, and major bleeding 
      were 1.56 (0.64-4.33), 1.67 (0.49-208.09), 1.17 (0.72-1.95), and 0.89 
      (0.08-7.05), respectively. When compared with either dose of UFH, the use of LMWH 
      has an effect similar to UFH on all four outcomes. CONCLUSIONS: Moderate-quality 
      evidence suggests that subcutaneous UFH bid and UFH tid do not differ in effect 
      on DVT, PE, major bleeding, and mortality. Either of the two dosing regimens of 
      UFH or LMWH appears to be a reasonable strategy for thromboprophylaxis in medical 
      patients. A future randomized trial comparing the two doses of UFH is very 
      unlikely, considering the very large sample size that would be required to 
      demonstrate a significant difference, which, if it exists, is undoubtedly small.
FAU - Phung, Olivia J
AU  - Phung OJ
AD  - College of Pharmacy, Western University of Health Sciences, Pomona, CA. 
      Electronic address: ophung@westernu.edu.
FAU - Kahn, Susan R
AU  - Kahn SR
AD  - Department of Medicine, McGill University, Montreal, QC, Canada.
FAU - Cook, Deborah J
AU  - Cook DJ
AD  - Departments of Medicine, Clinical Epidemiology, and Biostatistics, McMaster 
      University, Hamilton, ON, Canada.
FAU - Murad, Mohammad Hassan
AU  - Murad MH
AD  - Division of Preventive Medicine and Knowledge and Evaluation Research Unit, Mayo 
      Clinic, Rochester, MN.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20110224
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
EIN - Chest. 2015 Nov;148(5):1363. PMID: 26527438
MH  - Drug Administration Schedule
MH  - Heparin/*administration & dosage/adverse effects/therapeutic use
MH  - Heparin, Low-Molecular-Weight/*administration & dosage/adverse 
      effects/therapeutic use
MH  - Humans
MH  - Injections, Subcutaneous
MH  - Randomized Controlled Trials as Topic
MH  - Venous Thromboembolism/*prevention & control
EDAT- 2011/02/26 06:00
MHDA- 2011/10/14 06:00
CRDT- 2011/02/26 06:00
PHST- 2011/02/26 06:00 [entrez]
PHST- 2011/02/26 06:00 [pubmed]
PHST- 2011/10/14 06:00 [medline]
AID - S0012-3692(11)60411-X [pii]
AID - 10.1378/chest.10-3084 [doi]
PST - ppublish
SO  - Chest. 2011 Aug;140(2):374-381. doi: 10.1378/chest.10-3084. Epub 2011 Feb 24.