PMID- 32011451
OWN - NLM
STAT- MEDLINE
DCOM- 20200218
LR  - 20200616
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 99
IP  - 3
DP  - 2020 Jan
TI  - A meta-analysis of bridging anticoagulation between low molecular weight heparin 
      and heparin.
PG  - e18729
LID - 10.1097/MD.0000000000018729 [doi]
LID - e18729
AB  - BACKGROUND: Patients with mechanical heart valves (MHV) have an increased risk of 
      thromboembolic complications. Low molecular weight heparin (LMWH) and 
      unfractionated heparin (UFH) are often recommended for bridging anticoagulation; 
      however, it is not clear which strategy is more beneficial. METHODS: The PubMed, 
      EMBASE, and Cochrane databases were searched from January 1960 to March 2019. 
      Randomized controlled trials and observational studies were analyzed. The 
      Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the studies. 
      Stata 11.0 was used for the meta-analysis. RESULTS: A total of 6 publications 
      were included; 1366 events were selected, involving 852 events with LMWH and 514 
      events with UFH. The thromboembolism risk of the LMWH group was lower than that 
      of the UFH group (risk ratio [RR] = 0.34, 95% confidence interval [CI] 0.12-0.95, 
      P = .039). The incidence of major bleeding was lower in the LMWH group than in 
      the UFH group, albeit without statistical significance (RR = 0.94, 95% CI 
      0.68-1.30, P = .728), as was mortality (RR = 0.52, 95% CI 0.16-1.66, P = .271). 
      Subgroup analysis showed that LMWH cardiac surgery patients had a higher risk of 
      major bleeding compared with UFH cardiac surgery patients (RR = 1.17, 95% CI 
      0.72-1.90, P = .526); but among non-cardiac surgery patients, the LMWH group had 
      a lower risk of major bleeding than the UFH group (RR = 0.79, 95% CI 0.51-1.22, 
      P = .284), although the difference was not statistically significant. CONCLUSION: 
      Our meta-analysis suggests that LMWH not only reduces the risk of thromboembolism 
      in patients with MHV but also does not increase the risk of major bleeding. LMWH 
      may provide safer and more effective bridging anticoagulation than UFH in 
      patients with MHV. It is still necessary to conduct future randomized studies to 
      verify this conclusion.
FAU - Tao, Ende
AU  - Tao E
AD  - Department of Cardiovascular Surgery of The First Affiliated Hospital of Nanchang 
      University.
FAU - Luo, Yun Long
AU  - Luo YL
AD  - Department of Neurosurgery of Guandong 39 Brain Hospital, Guan Zhou, Guan dong.
FAU - Tao, Zhe
AU  - Tao Z
AD  - Department of Anesthesiology of The First Affiliated Hospital of Nanchang 
      University, Nan Chang, Jiang Xi, China.
FAU - Wan, Li
AU  - Wan L
AD  - Department of Cardiovascular Surgery of The First Affiliated Hospital of Nanchang 
      University.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/*therapeutic use
MH  - Heart Valve Prosthesis/*adverse effects
MH  - Heparin/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/*therapeutic use
MH  - Humans
MH  - Thromboembolism/*prevention & control
PMC - PMC7220302
COIS- The authors declare no competing interests. The authors have no conflicts of 
      interest to disclose.
EDAT- 2020/02/06 06:00
MHDA- 2020/02/19 06:00
PMCR- 2020/01/17
CRDT- 2020/02/04 06:00
PHST- 2020/02/04 06:00 [entrez]
PHST- 2020/02/06 06:00 [pubmed]
PHST- 2020/02/19 06:00 [medline]
PHST- 2020/01/17 00:00 [pmc-release]
AID - 00005792-202001170-00022 [pii]
AID - MD-D-19-02571 [pii]
AID - 10.1097/MD.0000000000018729 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2020 Jan;99(3):e18729. doi: 10.1097/MD.0000000000018729.