PMID- 25971389
OWN - NLM
STAT- MEDLINE
DCOM- 20160129
LR  - 20181203
IS  - 1432-1238 (Electronic)
IS  - 0342-4642 (Linking)
VI  - 41
IP  - 7
DP  - 2015 Jul
TI  - Thromboprophylaxis with low molecular weight heparin versus unfractionated 
      heparin in intensive care patients: a systematic review with meta-analysis and 
      trial sequential analysis.
PG  - 1209-19
LID - 10.1007/s00134-015-3840-z [doi]
AB  - PURPOSE: To compare benefits and harms of low molecular weight heparin (LMWH) 
      versus unfractionated heparin (UFH) as thromboprophylaxis in intensive care unit 
      (ICU) patients. METHODS: We conducted a systematic review with meta-analysis and 
      trial sequential analysis (TSA) of randomised controlled trials (RCTs) comparing 
      LMWH with UFH as thromboprophylaxis in adult ICU patients. We searched Ovid 
      Medline, PubMed, Embase, Cochrane Library, UpToDate, Guidelines International 
      Network, PROSPERO and the metaRegister of Controlled Trials through 3 December 
      2014. Random effects risk ratios (RR) and 95% confidence intervals (CI) were 
      derived for the endpoints deep vein thrombosis (DVT), pulmonary embolism (PE), 
      major bleeding, mortality and net clinical benefit (any DVT, any PE, major 
      bleeding and/or mortality). RESULTS: Eight RCTs (5567 patients) were included, 
      whereof two were considered to have overall low risk of bias. Pooled analyses 
      showed that LMWH compared with UFH reduced the risk of any DVT (RR 0.84, 95% CI 
      0.71-0.98, p = 0.03) and resulted in a net clinical benefit (RR 0.90, 95% CI 
      0.83-0.97, p = 0.01). There was no statistically significant difference in the 
      risk of any PE (RR 0.65, 95% CI 0.41-1.03, p = 0.06), major bleeding (RR 0.99, 
      95% CI 0.77-1.28, p = 0.96) or mortality (RR 0.93, 95% CI 0.78-1.12, p = 0.43). 
      TSA supported the results of the conventional analysis on the outcome net 
      clinical benefit but not on risk of any DVT. CONCLUSIONS: Evidence from this 
      systematic review revealed a beneficial effect of LMWH compared with UFH when 
      used as thromboprophylaxis in ICU patients.
FAU - Beitland, Sigrid
AU  - Beitland S
AD  - Institute of Clinical Medicine, University of Oslo, Oslo, Norway, 
      sigrid.beitland@medisin.uio.no.
FAU - Sandven, Irene
AU  - Sandven I
FAU - Kjaervik, Lill-Kristin
AU  - Kjaervik LK
FAU - Sandset, Per Morten
AU  - Sandset PM
FAU - Sunde, Kjetil
AU  - Sunde K
FAU - Eken, Torsten
AU  - Eken T
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20150514
PL  - United States
TA  - Intensive Care Med
JT  - Intensive care medicine
JID - 7704851
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Anticoagulants/*therapeutic use
MH  - Hemorrhage/chemically induced
MH  - Heparin/adverse effects/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/adverse effects/*therapeutic use
MH  - Humans
MH  - Intensive Care Units
MH  - Middle Aged
MH  - Pulmonary Embolism/*prevention & control
MH  - Venous Thrombosis/*prevention & control
EDAT- 2015/05/15 06:00
MHDA- 2016/01/30 06:00
CRDT- 2015/05/15 06:00
PHST- 2014/12/23 00:00 [received]
PHST- 2015/04/23 00:00 [accepted]
PHST- 2015/05/15 06:00 [entrez]
PHST- 2015/05/15 06:00 [pubmed]
PHST- 2016/01/30 06:00 [medline]
AID - 10.1007/s00134-015-3840-z [doi]
PST - ppublish
SO  - Intensive Care Med. 2015 Jul;41(7):1209-19. doi: 10.1007/s00134-015-3840-z. Epub 
      2015 May 14.