Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery
Background: Low molecular weight heparins (LMWHs) have become routine thromboprophylaxis in general surgery. However, their actual clinical effect, its magnitude relative to that of unfractionated heparin (UFH), and the optimal dose are still debated. Methods: A meta‐analysis was performed of all av...
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| Veröffentlicht in: | British journal of surgery 2001-07, Vol.88 (7), p.913-930 |
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| container_title | British journal of surgery |
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| creator | Mismetti, P. Laporte, S. Darmon, J.-Y. Buchmüller, A. Decousus, H. |
| description | Background:
Low molecular weight heparins (LMWHs) have become routine thromboprophylaxis in general surgery. However, their actual clinical effect, its magnitude relative to that of unfractionated heparin (UFH), and the optimal dose are still debated.
Methods:
A meta‐analysis was performed of all available randomized trials in general surgery comparing LMWH with placebo or no treatment, or with UFH.
Results:
Comparison versus placebo or no treatment confirmed that the significant reduction in asymptomatic deep vein thrombosis (DVT) obtained with LMWH (n = 513; relative risk (RR) 0·28 (95 per cent confidence interval 0·14–0·54)) was associated with a significant reduction in clinical pulmonary embolism (n = 5456; RR 0·25 (0·08–0·79)) and clinical venous thromboembolism (VTE) (n = 4890; RR 0·29 (0·11–0·73)), and a trend towards a reduction in overall mortality rate. Comparison versus UFH showed a trend in favour of LMWH, with a significant reduction in clinical VTE (P = 0·049), a trend also found for cancer surgery. LMWH at doses below 3400 anti‐Xa units seemed to be as effective as, and safer than, UFH, while higher doses yielded slightly superior efficacy but increased haemorrhagic risk, including that of major haemorrhage.
Conclusion:
Asymptomatic DVT may be regarded as a reliable surrogate endpoint for clinical outcome in studies investigating thromboprophylaxis in general surgery. LMWH seems to be as effective and safe as UFH. Determination of the optimal dose regimen of LMWH for this indication requires further investigation. © 2001 British Journal of Surgery Society Ltd |
| doi_str_mv | 10.1046/j.0007-1323.2001.01800.x |
| format | Article |
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Low molecular weight heparins (LMWHs) have become routine thromboprophylaxis in general surgery. However, their actual clinical effect, its magnitude relative to that of unfractionated heparin (UFH), and the optimal dose are still debated.
Methods:
A meta‐analysis was performed of all available randomized trials in general surgery comparing LMWH with placebo or no treatment, or with UFH.
Results:
Comparison versus placebo or no treatment confirmed that the significant reduction in asymptomatic deep vein thrombosis (DVT) obtained with LMWH (n = 513; relative risk (RR) 0·28 (95 per cent confidence interval 0·14–0·54)) was associated with a significant reduction in clinical pulmonary embolism (n = 5456; RR 0·25 (0·08–0·79)) and clinical venous thromboembolism (VTE) (n = 4890; RR 0·29 (0·11–0·73)), and a trend towards a reduction in overall mortality rate. Comparison versus UFH showed a trend in favour of LMWH, with a significant reduction in clinical VTE (P = 0·049), a trend also found for cancer surgery. LMWH at doses below 3400 anti‐Xa units seemed to be as effective as, and safer than, UFH, while higher doses yielded slightly superior efficacy but increased haemorrhagic risk, including that of major haemorrhage.
Conclusion:
Asymptomatic DVT may be regarded as a reliable surrogate endpoint for clinical outcome in studies investigating thromboprophylaxis in general surgery. LMWH seems to be as effective and safe as UFH. Determination of the optimal dose regimen of LMWH for this indication requires further investigation. © 2001 British Journal of Surgery Society Ltd</description><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1046/j.0007-1323.2001.01800.x</identifier><identifier>PMID: 11442521</identifier><identifier>CODEN: BJSUAM</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Science Ltd</publisher><subject>Anticoagulants - therapeutic use ; Biological and medical sciences ; Blood. Blood coagulation. Reticuloendothelial system ; Heparin, Low-Molecular-Weight - therapeutic use ; Humans ; Medical sciences ; Pharmacology. Drug treatments ; Randomized Controlled Trials as Topic ; Thromboembolism - prevention & control ; Venous Thrombosis - prevention & control</subject><ispartof>British journal of surgery, 2001-07, Vol.88 (7), p.913-930</ispartof><rights>2001 British Journal of Surgery Society Ltd</rights><rights>2001 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4484-683298143ba955e9bcc40217739f0204755acfae8d8b18c5bebb38ce4808404e3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1046%2Fj.0007-1323.2001.01800.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1046%2Fj.0007-1323.2001.01800.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,782,786,1419,27933,27934,45583,45584</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1058628$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11442521$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mismetti, P.</creatorcontrib><creatorcontrib>Laporte, S.</creatorcontrib><creatorcontrib>Darmon, J.-Y.</creatorcontrib><creatorcontrib>Buchmüller, A.</creatorcontrib><creatorcontrib>Decousus, H.</creatorcontrib><title>Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>Background:
Low molecular weight heparins (LMWHs) have become routine thromboprophylaxis in general surgery. However, their actual clinical effect, its magnitude relative to that of unfractionated heparin (UFH), and the optimal dose are still debated.
Methods:
A meta‐analysis was performed of all available randomized trials in general surgery comparing LMWH with placebo or no treatment, or with UFH.
Results:
Comparison versus placebo or no treatment confirmed that the significant reduction in asymptomatic deep vein thrombosis (DVT) obtained with LMWH (n = 513; relative risk (RR) 0·28 (95 per cent confidence interval 0·14–0·54)) was associated with a significant reduction in clinical pulmonary embolism (n = 5456; RR 0·25 (0·08–0·79)) and clinical venous thromboembolism (VTE) (n = 4890; RR 0·29 (0·11–0·73)), and a trend towards a reduction in overall mortality rate. Comparison versus UFH showed a trend in favour of LMWH, with a significant reduction in clinical VTE (P = 0·049), a trend also found for cancer surgery. LMWH at doses below 3400 anti‐Xa units seemed to be as effective as, and safer than, UFH, while higher doses yielded slightly superior efficacy but increased haemorrhagic risk, including that of major haemorrhage.
Conclusion:
Asymptomatic DVT may be regarded as a reliable surrogate endpoint for clinical outcome in studies investigating thromboprophylaxis in general surgery. LMWH seems to be as effective and safe as UFH. Determination of the optimal dose regimen of LMWH for this indication requires further investigation. © 2001 British Journal of Surgery Society Ltd</description><subject>Anticoagulants - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Blood. Blood coagulation. Reticuloendothelial system</subject><subject>Heparin, Low-Molecular-Weight - therapeutic use</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Pharmacology. Drug treatments</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Thromboembolism - prevention & control</subject><subject>Venous Thrombosis - prevention & control</subject><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpNkU1v1DAQhi0EokvhL6AcELeE8VfiSFygogXUlgNFcLMcd7LrxUkWO-nu_vs67NIi2bKled7RaB5CMgoFBVG-WxcAUOWUM14wAFoAVQDF7glZUF7KnNFSPSWLB-iEvIhxnUAOkj0nJ5QKwSSjC-KvcDS56Y3fRxezoc38sM26waOdvAnZFt1yNWYr3Jjg-iydcYXZJuAd9qMb-jmRvsMUUyEMXTNgut7FbmaX2GMwPotTWGLYvyTPWuMjvjq-p-TH-aebs8_55beLL2cfLnMrhBJ5qTirFRW8MbWUWDfWCmC0qnjdAgNRSWlsa1DdqoYqKxtsGq4sCgVKgEB-St4e-m7C8GfCOOrORYvemx7TpLqCOq2LQwJfH8Gp6fBWb4LrTNjrf_tJwJsjYKI1vg2mty4-ciBVyVTC3h-wrfO4_6-sZ116rWcTejahZ136ry690x-_fqelSPH8EHdxxN1D3ITfuqx4JfXP6wt9cyWrXxKuteD3bH-XvQ</recordid><startdate>200107</startdate><enddate>200107</enddate><creator>Mismetti, P.</creator><creator>Laporte, S.</creator><creator>Darmon, J.-Y.</creator><creator>Buchmüller, A.</creator><creator>Decousus, H.</creator><general>Blackwell Science Ltd</general><general>Wiley</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>200107</creationdate><title>Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery</title><author>Mismetti, P. ; Laporte, S. ; Darmon, J.-Y. ; Buchmüller, A. ; Decousus, H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4484-683298143ba955e9bcc40217739f0204755acfae8d8b18c5bebb38ce4808404e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Anticoagulants - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Blood. Blood coagulation. Reticuloendothelial system</topic><topic>Heparin, Low-Molecular-Weight - therapeutic use</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Pharmacology. Drug treatments</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Thromboembolism - prevention & control</topic><topic>Venous Thrombosis - prevention & control</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mismetti, P.</creatorcontrib><creatorcontrib>Laporte, S.</creatorcontrib><creatorcontrib>Darmon, J.-Y.</creatorcontrib><creatorcontrib>Buchmüller, A.</creatorcontrib><creatorcontrib>Decousus, H.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mismetti, P.</au><au>Laporte, S.</au><au>Darmon, J.-Y.</au><au>Buchmüller, A.</au><au>Decousus, H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>2001-07</date><risdate>2001</risdate><volume>88</volume><issue>7</issue><spage>913</spage><epage>930</epage><pages>913-930</pages><issn>0007-1323</issn><eissn>1365-2168</eissn><coden>BJSUAM</coden><abstract>Background:
Low molecular weight heparins (LMWHs) have become routine thromboprophylaxis in general surgery. However, their actual clinical effect, its magnitude relative to that of unfractionated heparin (UFH), and the optimal dose are still debated.
Methods:
A meta‐analysis was performed of all available randomized trials in general surgery comparing LMWH with placebo or no treatment, or with UFH.
Results:
Comparison versus placebo or no treatment confirmed that the significant reduction in asymptomatic deep vein thrombosis (DVT) obtained with LMWH (n = 513; relative risk (RR) 0·28 (95 per cent confidence interval 0·14–0·54)) was associated with a significant reduction in clinical pulmonary embolism (n = 5456; RR 0·25 (0·08–0·79)) and clinical venous thromboembolism (VTE) (n = 4890; RR 0·29 (0·11–0·73)), and a trend towards a reduction in overall mortality rate. Comparison versus UFH showed a trend in favour of LMWH, with a significant reduction in clinical VTE (P = 0·049), a trend also found for cancer surgery. LMWH at doses below 3400 anti‐Xa units seemed to be as effective as, and safer than, UFH, while higher doses yielded slightly superior efficacy but increased haemorrhagic risk, including that of major haemorrhage.
Conclusion:
Asymptomatic DVT may be regarded as a reliable surrogate endpoint for clinical outcome in studies investigating thromboprophylaxis in general surgery. LMWH seems to be as effective and safe as UFH. Determination of the optimal dose regimen of LMWH for this indication requires further investigation. © 2001 British Journal of Surgery Society Ltd</abstract><cop>Oxford, UK</cop><pub>Blackwell Science Ltd</pub><pmid>11442521</pmid><doi>10.1046/j.0007-1323.2001.01800.x</doi><tpages>18</tpages></addata></record> |
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| source | MEDLINE; Access via Wiley Online Library; Oxford University Press Journals All Titles (1996-Current) |
| subjects | Anticoagulants - therapeutic use Biological and medical sciences Blood. Blood coagulation. Reticuloendothelial system Heparin, Low-Molecular-Weight - therapeutic use Humans Medical sciences Pharmacology. Drug treatments Randomized Controlled Trials as Topic Thromboembolism - prevention & control Venous Thrombosis - prevention & control |
| title | Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery |
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