PMID- 24593838
OWN - NLM
STAT- MEDLINE
DCOM- 20150128
LR  - 20230829
IS  - 1538-7836 (Electronic)
IS  - 1538-7836 (Linking)
VI  - 12
IP  - 5
DP  - 2014 May
TI  - Efficacy and safety of low molecular weight heparin in patients with mechanical 
      heart valves: systematic review and meta-analysis.
PG  - 650-9
LID - 10.1111/jth.12544 [doi]
AB  - BACKGROUND: Low molecular weight heparins (LMWHs) are not approved for patients 
      with mechanical heart valves (MHVs). However, in several guidelines, temporary 
      LMWH off-label use in this clinical setting is considered to be a valid treatment 
      option. Therefore, we reviewed the efficacy and safety of LMWHs in patients with 
      MHVs. METHODS: MEDLINE and CENTRAL databases were searched from inception to June 
      2013. Review articles and references were also searched. We included experimental 
      and observational studies that compared LMWHs with unfractionated heparin (UFH) 
      or vitamin K antagonists (VKAs). Data were analyzed and pooled to estimate odds 
      ratios (ORs) with 95% confidence intervals (CIs) for thromboembolic and major 
      bleeding events. Statistical heterogeneity was evaluated with the I(2) -test. 
      RESULTS: Nine studies were included: one randomized controlled trial (RCT) and 
      eight observational studies, with a total of 1042 patients. No differences were 
      found between LMWHs and UFH/VKAs in the risk of thromboembolic events (OR 0.67; 
      95% CI 0.27-1.68; I(2) = 9%) or major bleeding events (OR 0.66; 95% CI 0.36-1.19; 
      I(2) = 0%). CONCLUSIONS: The best evidence available might support the temporary 
      use of LMWHs as a prophylactic treatment option in patients with MHVs. However, 
      conclusions are mostly based on observational data (with large CIs), and an 
      adequately powered RCT is urgently needed in this clinical setting.
CI  - (c) 2014 International Society on Thrombosis and Haemostasis.
FAU - Caldeira, D
AU  - Caldeira D
AD  - Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal; 
      Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, 
      University of Lisbon, Lisbon, Portugal.
FAU - David, C
AU  - David C
FAU - Santos, A T
AU  - Santos AT
FAU - Costa, J
AU  - Costa J
FAU - Pinto, F J
AU  - Pinto FJ
FAU - Ferreira, J J
AU  - Ferreira JJ
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
PL  - England
TA  - J Thromb Haemost
JT  - Journal of thrombosis and haemostasis : JTH
JID - 101170508
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 5Q7ZVV76EI (Warfarin)
SB  - IM
MH  - Anticoagulants/adverse effects/therapeutic use
MH  - Heart Valve Diseases/complications/therapy
MH  - *Heart Valve Prosthesis
MH  - Heart Valves/drug effects
MH  - Hemorrhage/prevention & control
MH  - Heparin, Low-Molecular-Weight/adverse effects/*therapeutic use
MH  - Humans
MH  - Observational Studies as Topic
MH  - Odds Ratio
MH  - Randomized Controlled Trials as Topic
MH  - Reproducibility of Results
MH  - Thromboembolism/complications/drug therapy/prevention & control
MH  - Warfarin/adverse effects/*therapeutic use
OTO - NOTNLM
OT  - coumarins
OT  - heart valve prosthesis
OT  - heparin
OT  - heparin, low-molecular-weight
OT  - warfarin
EDAT- 2014/03/07 06:00
MHDA- 2015/01/30 06:00
CRDT- 2014/03/06 06:00
PHST- 2013/12/04 00:00 [received]
PHST- 2014/03/06 06:00 [entrez]
PHST- 2014/03/07 06:00 [pubmed]
PHST- 2015/01/30 06:00 [medline]
AID - S1538-7836(22)03934-4 [pii]
AID - 10.1111/jth.12544 [doi]
PST - ppublish
SO  - J Thromb Haemost. 2014 May;12(5):650-9. doi: 10.1111/jth.12544.