The treatment of venous thromboembolism with low-molecular-weight heparins

Tomasz Bochenek; Rafal Nizankowski

doi:10.1160/TH11-08-0565

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2012; 107(04): 699-716
DOI: 10.1160/TH11-08-0565

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

The treatment of venous thromboembolism with low-molecular-weight heparins

A meta-analysis

Tomasz Bochenek

¹Department of Drug Management, Institute of Public Health, Collegium Medicum, Jagiellonian University, Krakow, Poland

,

Rafal Nizankowski

²Department of Angiology, 2nd Chair of Internal Medicine, Collegium Medicum, Jagiellonian University, Krakow, Poland

› Author Affiliations

Abstract

Summary

The currently recommended method of venous thromboembolism (VTE) treatment is the application of vitamin K antagonists (VKA) in most patients, and low-molecular-weight heparins (LMWH) in selected groups. The VKA dose adjustment is difficult which might well render the treatment ineffective. The study aimed to compare LMWH with VKA in treating VTE in terms of efficacy and safety. A systematic review of literature and the meta-analysis of the treatment results were performed. The main differences between LMWH and VKA in terms of their respective effectiveness in treating VTE consist in appreciably more advantageous effects of LMWH in preventing deep venous thrombosis (DVT). The key difference in terms of respective safety is the greater effectiveness of LMWH in preventing minor bleedings. The advantage of LMWH in cancer patients consists predominantly in a significantly better protection against DVT episodes, whereas the advantage of LMWH in non-cancer patients is mainly owed to better protection against minor bleedings. In none of the analysed outcomes of VTE treatment, the application of VKA proved to hold any advantage over LMWH. Although, arguably, there might well be sufficient medical grounds to propose more widespread use of LMWH, it still remains a debatable issue whether the currently used therapeutic standard should also be modified accordingly. Apart from the actual findings of the present meta-analysis, pertinent economic considerations must also be addressed.

Keywords

Venous thromboembolism - low-molecular-weight heparin/LMWH - vitamin K antagonist/VKA - systematic review - meta-analysis

Full Text

References

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