PMID- 31768282
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220411
IS  - 2229-5097 (Print)
IS  - 2152-7806 (Electronic)
IS  - 2152-7806 (Linking)
VI  - 10
DP  - 2019
TI  - A direct comparison of prophylactic low-molecular-weight heparin versus 
      unfractionated heparin in neurosurgery: A meta-analysis.
PG  - 202
LID - 10.25259/SNI_428_2019 [doi]
LID - 202
AB  - BACKGROUND: Several studies have confirmed the role of prophylactic 
      low-molecular-weight heparin (LMWH) for venous thromboembolism (VTE) in 
      neurosurgery; however, a paucity of literature has assessed its safety and 
      efficacy versus prophylactic unfractionated heparin (UFH). The objective is to 
      present a meta-analysis directly comparing prophylactic LMWH to UFH for the 
      prevention of VTE in neurosurgery. MATERIALS AND METHODS: Relevant studies that 
      directly compared LMWH to UFH for prophylaxis of VTE in neurosurgery and/or spine 
      surgery were identified by MEDLINE and EMBASE searches plus a scrutiny of 
      references from the original articles and reviews. Three randomized trials were 
      included in the meta-analysis. Efficacy and safety were ascertained per three 
      primary outcome measures: VTE, minor complications (decline in 
      hemoglobin/hematocrit), and major complications. Forest plot analysis provided 
      odds ratio (OR), 95% confidence intervals (CIs), and P-values. RESULTS: Of the 
      429 patients in the pooled analysis, the postoperative VTE rate of 5.6% (12/213) 
      after LMWH chemoprophylaxis was equivalent to 3.7% (8/216) after UFH 
      chemoprophylaxis (OR = 1.42, 95% CI 0.62-3.75, P = 0.308). Minor complications of 
      4.7% versus 4.6%, respectively, were nearly equal (OR = 1.01, 95% CI 0.41- 2.50, 
      P = 0.929). All four major complications included intracranial hemorrhages: three 
      after LMWH (1.4%) and one after UFH (0.5%) (OR = 2.32, 95% CI 0.34-16.01, P = 
      0.831). Tests for heterogeneity were nonsignificant in all three outcome 
      measures. CONCLUSION: Rates of VTE, minor complications, and major complications 
      were equivalent between prophylactic LMWH and UFH in neurosurgery. Further, 
      randomized clinical trials comparing the two heparin products are required to 
      elucidate superior safety and efficacy in neurosurgical patients.
CI  - Copyright: (c) 2019 Surgical Neurology International.
FAU - Macki, Mohamed
AU  - Macki M
AD  - Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
FAU - Fakih, Mohamed
AU  - Fakih M
AD  - Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
FAU - Anand, Sharath Kumar
AU  - Anand SK
AD  - Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
FAU - Suryadevara, Raviteja
AU  - Suryadevara R
AD  - Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
FAU - Elmenini, Jaafar
AU  - Elmenini J
AD  - Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
FAU - Chang, Victor
AU  - Chang V
AD  - Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20191018
PL  - United States
TA  - Surg Neurol Int
JT  - Surgical neurology international
JID - 101535836
PMC - PMC6826314
OTO - NOTNLM
OT  - Chemoprophylaxis
OT  - Heparin
OT  - Low-molecular-weight heparin
OT  - Meta-analysis
OT  - Neurosurgery
OT  - Prophylaxis
OT  - Unfractionated heparin
COIS- There are no conflicts of interest. How to cite this article: Macki M, Fakih M, 
      Anand SK, Suryadevara R, Elmenini J, Chang V. A direct comparison of prophylactic 
      low-molecular- weight heparin versus unfractionated heparin in neurosurgery: A 
      meta- analysis. Surg Neurol Int 2019;10:202.
EDAT- 2019/11/27 06:00
MHDA- 2019/11/27 06:01
PMCR- 2019/10/18
CRDT- 2019/11/27 06:00
PHST- 2019/09/13 00:00 [received]
PHST- 2019/09/23 00:00 [accepted]
PHST- 2019/11/27 06:00 [entrez]
PHST- 2019/11/27 06:00 [pubmed]
PHST- 2019/11/27 06:01 [medline]
PHST- 2019/10/18 00:00 [pmc-release]
AID - SNI-10-202 [pii]
AID - 10.25259/SNI_428_2019 [doi]
PST - epublish
SO  - Surg Neurol Int. 2019 Oct 18;10:202. doi: 10.25259/SNI_428_2019. eCollection 
      2019.