Low molecular weight heparin versus unfractionated heparin for perioperative thromboprophylaxis in patients with cancer

Akl, Elie A.; Kahale, Lara A; Sperati, Francesca; Neumann, Ignacio; Labedi, Nawman; Terrenato, Irene; Barba, Maddalena; Sempos, Elena V.; Muti, Paola; Cook, Deborah J.; Schünemann, Holger J.

doi:10.1002/14651858.cd009447.pub2

Cited by 38 publications

(13 citation statements)

References 50 publications

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“…In a 2014 meta-analysis of 16 RCTs, of which 13 compared LMWH to UFH, two studies compared fondaparinux vs. heparin, and one compared dalteparin to tinzaparin. Eleven studies confirmed a statistically significant reduction in mortality in the 3-month follow-up period in favor of LMWH in relation to UFH (RR 0.71; 95% CI: 0.52-0.98) [66]. There was no difference in recurrence of thrombosis between LMWH and UFH used as initial treatment (RR 0.78; 95% CI: 0.29-2.08).…”

Section: Initial (5-21 Days) and Primary (3-6 Months) Treatment Of Vtementioning

confidence: 90%

“…The effectiveness of low doses of unfractionated heparin (LDUH) in the prophylaxis of VTE in high-risk surgical patients has been well documented. However, in everyday clinical practice, for various reasons, this method of prophylaxis is less and less important compared with the use of LMWH; and it should be noted that both methods show high and comparable effectiveness [55][56][57][58][59][60][61][62][63][64][65][66].…”

Section: Recommendation 28mentioning

confidence: 99%

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Wytyczne leczenia i profilaktyki żylnej choroby zatorowo-zakrzepowej u chorych onkologicznych leczonych operacyjnie z uwzględnieniem chorych poniżej 18. roku życia

Krasiński¹,

Urbanek²,

Undas³

et al. 2021

Acta Angiologica

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Section: Initial (5-21 Days) and Primary (3-6 Months) Treatment Of Vtementioning

confidence: 90%

Section: Recommendation 28mentioning

confidence: 99%

Wytyczne leczenia i profilaktyki żylnej choroby zatorowo-zakrzepowej u chorych onkologicznych leczonych operacyjnie z uwzględnieniem chorych poniżej 18. roku życia

Krasiński¹,

Urbanek²,

Undas³

et al. 2021

Acta Angiologica

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“…The benefits of UFH and LMWH remain to be properly studied in relation to flaps, but there does not seem to be increased complications with preoperative anti-coagulation. 50,51 However, preoperative thromboprophylaxis may provide ancillary benefits such as reducing the rates of VTEs after microsurgery. Bertolaccini et al 52 investigated the pharmacodynamics of fixed-dosed intra-operative UFH (500 U/h) and discovered that it did not reach therapeutic levels to prevent VTEs.…”

Section: Preoperative Managementmentioning

confidence: 99%

Multidisciplinary Practice Variations of Anti-Thrombotic Strategies for Free Tissue Transfers

et al. 2021

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Background: Venous thrombosis, the leading cause of free flap failure, may have devastating consequences. Many anti-thrombotic agents and protocols have been described for prophylaxis and treatment of venous thrombosis in free flaps. Methods: National surveys were distributed to microsurgeons (of both Plastics and ENT training) and hematology and thrombosis specialists. Data were collected on routine screening practices, perceived risk factors for flap failure, and pre-, intra-, and post-operative anti-thrombotic strategies. Results: There were 722 surveys distributed with 132 (18%) respondents, consisting of 102 surgeons and 30 hematologists. Sixty-five surgeons and 9 hematologists routinely performed or managed patients with free flaps. The top 3 perceived risk factors for flap failure according to surgeons were medical co-morbidities, past arterial thrombosis, and thrombophilia. Hematologists, however, reported diabetes, smoking, and medical co-morbidities as the most important risk factors. Fifty-four percent of physicians routinely used unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) as a preoperative agent. Surgeons routinely flushed the flap with heparin (37%), used UFH IV (6%), or both (8%) intra-operatively. Surgeons used a range of post-operative agents such as UFH, LMWH, aspirin, and dextran while hematologists preferred LMWH. There was variation of management strategies if flap thrombosis occurred. Different strategies consisted of changing recipient vessels, UFH IV, flushing the flap, adding post-operative agents, or a combination of strategies. Conclusions: There are diverse practice variations in anti-thrombotic strategies for free tissue transfers and a difference in perceived risk factors for flap failure that may affect patient management.

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“…We have used this approach in several recently published Cochrane and non-Cochrane reviews [22][23][24][25][26][27][28][29][30][31][32] . One of these studies assessed probiotics for the prevention of Clostridium difficile infection (CDI) 28 .…”

Section: Illustrative Examplesmentioning

confidence: 99%

GRADE guidelines 17: assessing the risk of bias associated with missing participant outcome data in a body of evidence

Guyatt

Ebrahim

Alonso‐Coello

et al. 2017

Journal of Clinical Epidemiology

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130

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Low molecular weight heparin versus unfractionated heparin for perioperative thromboprophylaxis in patients with cancer

Abstract: Low molecular weight heparin versus unfractionated heparin for perioperative thromboprophylaxis in patients with cancer.

Cited by 38 publications

References 50 publications

Wytyczne leczenia i profilaktyki żylnej choroby zatorowo-zakrzepowej u chorych onkologicznych leczonych operacyjnie z uwzględnieniem chorych poniżej 18. roku życia

Wytyczne leczenia i profilaktyki żylnej choroby zatorowo-zakrzepowej u chorych onkologicznych leczonych operacyjnie z uwzględnieniem chorych poniżej 18. roku życia

Multidisciplinary Practice Variations of Anti-Thrombotic Strategies for Free Tissue Transfers

GRADE guidelines 17: assessing the risk of bias associated with missing participant outcome data in a body of evidence

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