PMID- 22744711
OWN - NLM
STAT- MEDLINE
DCOM- 20130123
LR  - 20240109
IS  - 1875-9114 (Electronic)
IS  - 0277-0008 (Linking)
VI  - 32
IP  - 9
DP  - 2012 Sep
TI  - Comparative effectiveness of low-molecular-weight heparins versus other 
      anticoagulants in major orthopedic surgery: a systematic review and 
      meta-analysis.
PG  - 799-808
LID - 10.1002/j.1875-9114.2012.01106.x [doi]
AB  - STUDY OBJECTIVE: To evaluate the comparative efficacy and safety of 
      low-molecular-weight heparins (LMWHs) versus other anticoagulants as venous 
      thromboembolism prophylaxis in major orthopedic surgery. DESIGN: Systematic 
      review with meta-analysis of 37 randomized controlled trials. PATIENTS: Patients 
      undergoing total hip replacement, total knee replacement, or hip fracture surgery 
      who received prophylaxis with a LMWH or another anticoagulant. MEASUREMENTS AND 
      MAIN RESULTS: We conducted a systematic literature search of the MEDLINE, 
      Cochrane Central Register of Controlled Trials, and Scopus databases (1980-July 
      2011) to identify randomized controlled trials. Trials were included if they 
      directly compared LMWH prophylaxis with another anticoagulant class and reported 
      outcomes of interest. Compared with patients who received unfractionated heparin 
      (UFH), patients who received LMWHs had fewer pulmonary embolism, total deep vein 
      thrombosis (DVT), major bleeding, and heparin-induced thrombocytopenia events. 
      Compared with patients who received vitamin K antagonists (VKAs), patients who 
      received LMWHs had fewer total DVT and distal DVT events but reported increased 
      major bleeding, minor bleeding, and surgical site bleeding events. Major efficacy 
      end points such as symptomatic venous thromboembolism, pulmonary embolism, and 
      nonfatal pulmonary embolism showed similar benefits of therapy with LMWHs and 
      VKAs. Compared with patients receiving factor Xa inhibitors, patients who 
      received LMWHs had more major venous thromboembolism, pulmonary embolism, total 
      DVT, asymptomatic DVT, proximal DVT, and distal DVT events but fewer major 
      bleeding events. Compared with patients receiving direct thrombin inhibitors 
      (DTIs), patients who received LMWHs had more major venous thromboembolism, total 
      DVT, and proximal DVT events without significantly negatively affecting bleeding. 
      However, patients who received LMWHs had fewer distal DVT events versus those who 
      received DTIs. Subgroup analyses indicated differences based on the surgical 
      procedure and individual drug within certain pharmacologic classes. CONCLUSION: 
      According to moderate-to-high strength of evidence, LMWH prophylaxis provides 
      additional benefits with less harm compared with UFH. With predominantly moderate 
      strength of evidence, the balance of benefits to harms for factor Xa inhibitors 
      or DTIs compared with LMWHs seems favorable. With predominantly low-to-moderate 
      strength of evidence, the known benefits in total DVT and distal DVT with LMWHs 
      versus VKAs may not be sufficient to counteract the increased risk of bleeding.
CI  - (c) 2012 Pharmacotherapy Publications, Inc. All rights reserved.
FAU - Sobieraj, Diana M
AU  - Sobieraj DM
AD  - University of Connecticut/Hartford Hospital Evidence-Based Practice Center, 
      Hartford, Connecticut 06102-5037, USA.
FAU - Coleman, Craig I
AU  - Coleman CI
FAU - Tongbram, Vanita
AU  - Tongbram V
FAU - Chen, Wendy
AU  - Chen W
FAU - Colby, Jennifer
AU  - Colby J
FAU - Lee, Soyon
AU  - Lee S
FAU - Kluger, Jeffrey
AU  - Kluger J
FAU - Makanji, Sagar
AU  - Makanji S
FAU - Ashaye, Ajibade
AU  - Ashaye A
FAU - White, C Michael
AU  - White CM
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20120628
PL  - United States
TA  - Pharmacotherapy
JT  - Pharmacotherapy
JID - 8111305
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 12001-79-5 (Vitamin K)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Arthroplasty, Replacement, Hip/adverse effects/methods
MH  - Arthroplasty, Replacement, Knee/adverse effects/methods
MH  - Hemorrhage/chemically induced/epidemiology
MH  - Heparin/adverse effects/therapeutic use
MH  - Heparin, Low-Molecular-Weight/adverse effects/*therapeutic use
MH  - Hip Fractures/surgery
MH  - Humans
MH  - Randomized Controlled Trials as Topic
MH  - Thromboembolism/etiology/*prevention & control
MH  - Vitamin K/antagonists & inhibitors
EDAT- 2012/06/30 06:00
MHDA- 2013/01/24 06:00
CRDT- 2012/06/30 06:00
PHST- 2012/06/30 06:00 [entrez]
PHST- 2012/06/30 06:00 [pubmed]
PHST- 2013/01/24 06:00 [medline]
AID - 10.1002/j.1875-9114.2012.01106.x [doi]
PST - ppublish
SO  - Pharmacotherapy. 2012 Sep;32(9):799-808. doi: 10.1002/j.1875-9114.2012.01106.x. 
      Epub 2012 Jun 28.