PMID: 9189079Jun 1, 1997Paper

Low molecular weight heparin and unfractionated heparin in thrombosis prophylaxis after major surgical intervention: update of previous meta-analyses

The British Journal of Surgery
A KochN Victor

Abstract

Previous meta-analyses comparing low molecular weight heparin (LMWH) and unfractionated heparin for thrombosis prophylaxis after surgical interventions need updating. This is a publication-based meta-analysis of 36 double-blind studies including 16583 patients. Main outcome measures are incidence of deep vein thrombosis (efficacy) and wound haematoma (safety). In general surgery there is no increased efficacy in favour of LMWH (odds ratio (OR) 0.88, 95 per cent confidence interval (c.i.) 0.60-1.30) but there exists a higher incidence of bleeding complications (OR 1.47, 95 per cent c.i. 1.07-2.01). Low-dose LMWH is equally efficacious (OR 1.03, 95 per cent c.i. 0.85-1.26) but safer than unfractionated heparin (OR 0.68, 95 per cent c.i. 0.56-0.82). In orthopaedic surgery there is a trend towards an increased efficacy for LMWH (OR 0.83, 95 per cent c.i. 0.68-1.02) with equivalent safety (OR 0.96, 95 per cent c.i. 0.68-1.36). A superiority of LMWH is suggested but heterogeneity might make generalizability to future patients questionable. A meta-analysis on individual patient data should be the next step before randomizing additional patients in future trials.

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Citations

Oct 17, 2006·Diseases of the Colon and Rectum·Thomas J StahlUNKNOWN Standards Practice Task Force of The American Society of Colon and Rectal Surgeons
Feb 16, 2000·Obstetrics and Gynecology·G L MaxwellD L Clarke-Pearson
Feb 11, 2000·Thrombosis Research·G Agnelli, F Sonaglia
Dec 22, 2004·International Journal of Technology Assessment in Health Care·James MuntzMatthias Egger
Feb 2, 2010·Clinics in Colon and Rectal Surgery·Michael P McNally, Christopher J Burns
Jul 27, 2000·Current Opinion in Pulmonary Medicine·D L Ornstein, L R Zacharski
Jan 27, 2007·Plastic and Reconstructive Surgery·George BroughtonSpencer A Brown
Feb 25, 2005·Annals of Surgery·Elijah DixonChristopher Doig
Jul 3, 2008·Plastic and Reconstructive Surgery·Daniel A HatefSpencer A Brown
Jan 6, 2010·Plastic and Reconstructive Surgery·Daniel A HatefJeffrey M Kenkel
Mar 8, 2012·Future Medicinal Chemistry·Sayaka Masuko, Robert J Linhardt
Sep 8, 2012·World Journal of Surgery·Kristoffer LassenUNKNOWN International Association for Surgical Metabolism and Nutrition (IASMEN)
May 21, 2011·World Journal of Surgery·David Bergqvist
Nov 28, 2015·Anesthesiology Clinics·Arvind Chandrakantan, Tong Joo Gan
Jul 23, 2014·The British Journal of Surgery·K MortensenUNKNOWN Enhanced Recovery After Surgery (ERAS®) Group
Dec 17, 2008·British Journal of Haematology·Beverley J Hunt
Mar 27, 2013·Clinical and Applied Thrombosis/hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis·Andrew NicolaidesUNKNOWN International Union of Angiology and Union Internationale du Phlebologie
Nov 16, 2011·Clinical and Applied Thrombosis/hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis·Sylvia HaasPeter Bramlage
Aug 31, 2004·Journal of Thrombosis and Haemostasis : JTH·Y ChengG Cheng
Mar 24, 2007·The British Journal of Surgery·S PatiarG J Byrne
Aug 8, 2008·Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis·Hiromi UgakiTomio Kawasaki

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