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Thromb Haemost 2000; 83(01): 14-19
DOI: 10.1055/s-0037-1613749
Commentary
Schattauer GmbH

Prevention of Venous Thromboembolism in Internal Medicine with Unfractionated or Low-molecular-weight Heparins: A Meta-analysis of Randomised Clinical Trials

Patrick Mismetti
1   From the Clinical Pharmacology Unit, France
,
Silvy Laporte-Simitsidis
1   From the Clinical Pharmacology Unit, France
,
Bernard Tardy
2   From the Intensive Care Unit, Thrombosis Research Group, University Hospital of Saint-Etienne, France
,
Michel Cucherat
3   From the Clinical Pharmacology Unit, Cardiological Hospital of Lyon, France
,
Andréa Buchmüller
1   From the Clinical Pharmacology Unit, France
,
Daphné Juillard-Delsart
1   From the Clinical Pharmacology Unit, France
,
Hervé Decousus
1   From the Clinical Pharmacology Unit, France
› Author Affiliations
Further Information

Publication History

Received 16 March 1999

Accepted after revision 25 August 1999

Publication Date:
06 December 2017 (online)

Also available at
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Summary

Background

The prevention of venous thromboembolic disease is less studied in medical patients than in surgery.

Methods

We performed a meta-analysis of randomised trials studying prophylactic unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) in internal medicine, excluding acute myocardial infarction or ischaemic stroke. Deepvein thrombosis (DVT) systematically detected at the end of the treatment period, clinical pulmonary embolism (PE), death and major bleeding were recorded.

Results

Seven trials comparing a prophylactic heparin treatment to a control (15,095 patients) were selected. A significant decrease in DVT and in clinical PE were observed with heparins as compared to control (risk reductions = 56% and 58% respectively, p <0.001 in both cases), without significant difference in the incidence of major bleedings or deaths. Nine trials comparing LMWH to UFH (4,669 patients) were also included. No significant effect was observed on either DVT, clinical PE or mortality. However LMWH reduced by 52% the risk of major haemorrhage (p = 0.049).

Conclusions

This meta-analysis, based on the pooling of data available for several heparins, shows that heparins are beneficial in the prevention of venous thromboembolism in internal medicine.

Keywords

Heparin - internal medicine - venous thromboembolism - prophylaxis - meta-analysis
 

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