PMID- 36401460
OWN - NLM
STAT- MEDLINE
DCOM- 20221122
LR  - 20230103
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 101
IP  - 46
DP  - 2022 Nov 18
TI  - Unfractionated heparin or low-molecular-weight heparin for venous thromboembolism 
      prophylaxis after hepatic resection: A meta-analysis.
PG  - e31948
LID - 10.1097/MD.0000000000031948 [doi]
LID - e31948
AB  - BACKGROUND: Two systematic reviews summarized the efficacy and safety of 
      pharmacological prophylaxis for venous thromboembolism (VTE) after hepatic 
      resection, but both lacked a discussion of the differences in the pharmacological 
      prophylaxis of VTE in different ethnicities. Therefore, we aimed to evaluate the 
      efficacy and safety of low-molecular-weight heparin (LMWH) or unfractionated 
      heparin (UFH) for VTE prophylaxis in Asian and Caucasian patients who have 
      undergone hepatic resection. METHODS: We searched PubMed, Web of Science, Embase, 
      China National Knowledge Infrastructure, Wanfang Data, and VIP databases for 
      studies reporting the primary outcomes of VTE incidence, bleeding events, and 
      all-cause mortality from January 2000 to July 2022. RESULTS: Ten studies 
      involving 4318 participants who had undergone hepatic resection were included: 6 
      in Asians and 4 in Caucasians. A significant difference in VTE incidence was 
      observed between the experimental and control groups (odds ratio [OR] = 0.39, 95% 
      confidence interval [CI]: 0.20, 0.74, P = .004). No significant difference in 
      bleeding events and all-cause mortality was observed (OR = 1.29, 95% CI: 0.80, 
      2.09, P = .30; OR = 0.71, 95% CI: 0.36, 1.42, P = .33, respectively). Subgroup 
      analyses stratified by ethnicity showed a significant difference in the incidence 
      of VTE in Asians (OR = 0.16, 95% CI: 0.06, 0.39, P < .0001), but not in 
      Caucasians (OR = 0.69, 95% CI: 0.39, 1.23, P = .21). No significant differences 
      in bleeding events were found between Asians (OR = 1.60, 95% CI: 0.48, 5.37, P = 
      .45) and Caucasians (OR = 1.11, 95% CI: 0.58, 2.12, P = .75). The sensitivity 
      analysis showed that Ejaz's study was the main source of heterogeneity, and when 
      Ejaz's study was excluded, a significant difference in VTE incidence was found in 
      Caucasians (OR = 0.58, 95% CI: 0.36, 0.93, P = .02). CONCLUSION: This study's 
      findings indicate that the application of UFH or LMWH for VTE prophylaxis after 
      hepatic resection is efficacious and safe in Asians and Caucasians. It is 
      necessary for Asians to receive drug prophylaxis for VTE after hepatic resection. 
      This study can provide a reference for the development of guidelines in the 
      future, especially regarding the pharmacological prevention of VTE in different 
      ethnicities.
CI  - Copyright (c) 2022 the Author(s). Published by Wolters Kluwer Health, Inc.
FAU - Zhang, Wentao
AU  - Zhang W
AD  - Department of Hepatobiliary and Pancreatic Surgery, Qinghai University Affiliated 
      Hospital, Xining, Qinghai Province, China.
FAU - Wei, Xinchun
AU  - Wei X
AD  - Department of Gastrointestinal Surgery, Qinghai University Affiliated Hospital, 
      Xining, Qinghai Province, China.
FAU - Yang, Shiwei
AU  - Yang S
AD  - Organ Transplant Center and Department of Hepatobiliary Surgery, China-Japan 
      Friendship Hospital, Beijing, China.
FAU - Du, Changhong
AU  - Du C
AD  - Department of Cardiology, The First People's Hospital of Guangyuan, Guangyuan, 
      Sichuan Province, China.
FAU - Hu, Baoyue
AU  - Hu B
AUID- ORCID: 0000-0001-5530-3840
AD  - Department of Emergency, Pizhou Hospital of Traditional Chinese Medicine, Pizhou, 
      Jiangsu Province, China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Humans
MH  - *Heparin, Low-Molecular-Weight/therapeutic use
MH  - *Venous Thromboembolism/etiology/prevention & control/epidemiology
MH  - Heparin/therapeutic use
MH  - Treatment Outcome
MH  - Anticoagulants/therapeutic use
MH  - Hemorrhage/epidemiology
PMC - PMC9678573
COIS- The authors have no funding and conflicts of interest to disclose.
EDAT- 2022/11/20 06:00
MHDA- 2022/11/23 06:00
PMCR- 2022/11/18
CRDT- 2022/11/19 01:04
PHST- 2022/11/19 01:04 [entrez]
PHST- 2022/11/20 06:00 [pubmed]
PHST- 2022/11/23 06:00 [medline]
PHST- 2022/11/18 00:00 [pmc-release]
AID - 00005792-202211180-00100 [pii]
AID - 10.1097/MD.0000000000031948 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2022 Nov 18;101(46):e31948. doi: 
      10.1097/MD.0000000000031948.