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

Patrick Mismetti; Silvy Laporte-Simitsidis; Bernard Tardy; Michel Cucherat; Andréa Buchmüller; Daphné Juillard-Delsart; Hervé Decousus

doi:10.1055/s-0037-1613749

Thrombosis and Haemostasis, Table of Contents

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

¹From the Clinical Pharmacology Unit, France

,

Silvy Laporte-Simitsidis

¹From the Clinical Pharmacology Unit, France

,

Bernard Tardy

²From the Intensive Care Unit, Thrombosis Research Group, University Hospital of Saint-Etienne, France

,

Michel Cucherat

³From the Clinical Pharmacology Unit, Cardiological Hospital of Lyon, France

,

Andréa Buchmüller

¹From the Clinical Pharmacology Unit, France

,

Daphné Juillard-Delsart

¹From the Clinical Pharmacology Unit, France

,

Hervé Decousus

¹From the Clinical Pharmacology Unit, France

› Author Affiliations

Abstract

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

Full Text

References

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