Key result
LMWH cuts major bleeding ~40% and reduces mortality vs UFH for initial VTE treatment.
Why the study?
Does low molecular weight heparin reduce recurrence of venous thromboembolism, bleeding, and mortality compared with unfractionated heparin in the initial treatment of venous thromboembolism?
Meta-Analysis
Does low molecular weight heparin reduce recurrence of venous thromboembolism, bleeding, and mortality compared with unfractionated heparin in the initial treatment of venous thromboembolism?
Low molecular weight heparin is an effective and safe alternative to unfractionated heparin for the initial treatment of venous thromboembolism, offering significant reductions in major bleeding and mortality.
Answers are grounded in this paper and cite their sources.
Supports LMWH over UFH for initial VTE to reduce bleeding and mortality; confirms RCT meta-analysis benefits irrespective of cancer prevalence.
In this review, we analyze data from randomized trials in which low molecular weight heparin was compared with unfractionated heparin, both to estimate the treatment effect of low molecular weight heparin in the initial treatment of venous thromboembolism and to evaluate the effect of the varied proportion of included cancer patients (6% to 22.7%) on the incidence of outcome events (recurrence of venous thromboembolism, bleeding, and mortality) and on the estimated treatment effect. Low molecular weight heparin has been extensively investigated in patients with deep vein thrombosis, but few trials have included patients with pulmonary embolism. The risk of recurrence of venous thromboembolism (odds ratio, 0.77; 95% CI, 0.56-1.04), major bleeding (odds ratio, 0.60; 95% CI, 0.38-0.95), and mortality (odds ratio, 0.72; 95% CI, 0.55-0.96) was less with low molecular weight heparins compared with unfractionated heparin. The proportion of cancer patients in these studies had a statistically significant effect on the incidence of recurrent venous thromboembolism (P = 0.03) and mortality (P = 0.002), but no influence on the estimated treatment effects of low molecular weight heparins. Low molecular weight heparin is effective and safe in the initial treatment of venous thromboembolism.
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Hettiarachchi et al. (1998) conducted a meta-analysis in venous thromboembolism. Low molecular weight heparin vs. unfractionated heparin was evaluated on recurrence of venous thromboembolism (OR 0.77, 95% CI 0.56-1.04). Low molecular weight heparin compared with unfractionated heparin for initial VTE treatment reduced major bleeding and mortality.
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