PMID- 27709864
OWN - NLM
STAT- MEDLINE
DCOM- 20170329
LR  - 20181113
IS  - 1598-6357 (Electronic)
IS  - 1011-8934 (Print)
IS  - 1011-8934 (Linking)
VI  - 31
IP  - 11
DP  - 2016 Nov
TI  - Pharmacological and Mechanical Thromboprophylaxis in Critically Ill Patients: a 
      Network Meta-Analysis of 12 Trials.
PG  - 1828-1837
LID - 10.3346/jkms.2016.31.11.1828 [doi]
AB  - Thromboprophylaxis for venous thromboembolism is widely used in critically ill 
      patients. However, only limited evidence exists regarding the efficacy and safety 
      of the various thromboprophylaxis techniques, especially mechanical 
      thromboprophylaxis. Therefore, we performed meta-analysis of randomized 
      controlled trials (RCTs) that compared the overall incidence of deep vein 
      thrombosis (DVT) for between unfractionated heparin (UFH), low-molecular-weight 
      heparin (LMWH), and intermittent pneumatic compression (IPC) in critically ill 
      patients. A Bayesian random effects model for multiple treatment comparisons was 
      constructed. The primary outcome measure was the overall incidence of DVT at the 
      longest follow-up. The secondary outcome measure was the incidence of major 
      bleeding, as defined by the original trials. Our analysis included 8,622 patients 
      from 12 RCTs. The incidence of DVT was significantly lower in patients treated 
      with UFH (OR, 0.45; 95% CrI, 0.22-0.83) or LMWH (OR, 0.38; 95% CrI, 0.18-0.72) 
      than in patients in the control group. IPC was associated with a reduced 
      incidence of DVT compared to the control group, but the effect was not 
      statistically significant (OR, 0.50; 95% CrI, 0.20-1.23). The risk of DVT was 
      similar for patients treated with UFH and LMWH (OR, 1.16; 95% CrI, 0.68-2.11). 
      The risk of major bleeding was similar between the treatment groups in medical 
      critically ill patients and also in critically ill patients with a high risk of 
      bleeding. In critically ill patients, the efficacy of mechanical 
      thromboprophylaxis in reducing the risk of DVT is not as robust as those of 
      pharmacological thromboprophylaxis.
FAU - Park, Jonghanne
AU  - Park J
AUID- ORCID: 0000-0002-8860-8445
AD  - Department of Internal Medicine and Cardiovascular Center, Seoul National 
      University Hospital, Seoul, Korea.
FAU - Lee, Joo Myung
AU  - Lee JM
AUID- ORCID: 0000-0002-2178-4014
AD  - Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke 
      Institute, Samsung Medical Center, Seoul, Korea.
FAU - Lee, Jeong Seok
AU  - Lee JS
AUID- ORCID: 0000-0001-8261-7044
AD  - Department of Internal Medicine, Seoul National University Hospital, Seoul, 
      Korea.
FAU - Cho, Young Jae
AU  - Cho YJ
AUID- ORCID: 0000-0001-6943-4462
AD  - Division of Pulmonary and Critical Care Medicine, Department of Internal 
      Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. 
      lungdrcho@gmail.com, lungdrcho@snubh.org.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PL  - Korea (South)
TA  - J Korean Med Sci
JT  - Journal of Korean medical science
JID - 8703518
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/*therapeutic use
MH  - Bayes Theorem
MH  - Critical Illness
MH  - Databases, Factual
MH  - Heparin/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Incidence
MH  - Intermittent Pneumatic Compression Devices
MH  - Odds Ratio
MH  - Venous Thromboembolism/*prevention & control
MH  - Venous Thrombosis/epidemiology/etiology
PMC - PMC5056218
OTO - NOTNLM
OT  - Deep Vein Thrombosis
OT  - Meta-Analysis
OT  - Venous Thrombosis
COIS- The authors have no potential conflicts of interest to disclose.
EDAT- 2016/10/07 06:00
MHDA- 2017/03/31 06:00
PMCR- 2016/11/01
CRDT- 2016/10/07 06:00
PHST- 2016/03/09 00:00 [received]
PHST- 2016/08/12 00:00 [accepted]
PHST- 2016/10/07 06:00 [entrez]
PHST- 2016/10/07 06:00 [pubmed]
PHST- 2017/03/31 06:00 [medline]
PHST- 2016/11/01 00:00 [pmc-release]
AID - 31.1828 [pii]
AID - 10.3346/jkms.2016.31.11.1828 [doi]
PST - ppublish
SO  - J Korean Med Sci. 2016 Nov;31(11):1828-1837. doi: 10.3346/jkms.2016.31.11.1828.