A meta-analysis of bridging anticoagulation between low molecular weight heparin and heparin

Abstract

Background: Patients with mechanical heart valves (MHV) have an increased risk of thromboembolic complications. Low molecular weight heparin (LMWH) and unfractionated heparin (UFH) are often recommended for bridging anticoagulation; however, it is not clear which strategy is more beneficial. Methods: The PubMed, EMBASE, and Cochrane databases were searched from January 1960 to March 2019. Randomized controlled trials and observational studies were analyzed. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the studies. Stata 11.0 was used for the meta-analysis. Results: A total of 6 publications were included; 1366 events were selected, involving 852 events with LMWH and 514 events with UFH. The thromboembolism risk of the LMWH group was lower than that of the UFH group (risk ratio [RR] = 0.34, 95% confidence interval [CI] 0.12–0.95, P = .039). The incidence of major bleeding was lower in the LMWH group than in the UFH group, albeit without statistical significance (RR = 0.94, 95% CI 0.68–1.30, P = .728), as was mortality (RR = 0.52, 95% CI 0.16–1.66, P = .271). Subgroup analysis showed that LMWH cardiac surgery patients had a higher risk of major bleeding compared with UFH cardiac surgery patients (RR = 1.17, 95% CI 0.72–1.90, P = .526); but among non-cardiac surgery patients, the LMWH group had a lower risk of major bleeding than the UFH group (RR = 0.79, 95% CI 0.51–1.22, P = .284), although the difference was not statistically significant. Conclusion: Our meta-analysis suggests that LMWH not only reduces the risk of thromboembolism in patients with MHV but also does not increase the risk of major bleeding. LMWH may provide safer and more effective bridging anticoagulation than UFH in patients with MHV. It is still necessary to conduct future randomized studies to verify this conclusion.

Can Heparin Improve Clinical Outcomes in Cardiac Arrest? A Retrospective Cohort Study from the EICU Collaborative Research Database

“…As common anticoagulants, in addition to large differences in molecular weight, UFH and LMWH also have large differences in terms of mechanism of action, pharmacokinetics, and risk of adverse reactions [22]. UFH can act on variety of thrombin enzymes and can also act on platelets, which have a shorter half-life, lower bioavailability, and pose a higher risk of bleeding [23]. To further determine whether there is a difference between the two types of heparin, we investigated their effects on clinical outcomes.…”

Perioperative Management of Dental Surgery Patients Chronically Taking Antithrombotic Medications

“…Two types of heparins are used in clinical practice: unfractionated heparins (UFH) and low molecular weight heparins (LMWH) [ 19 , 20 ].…”

“…When administered intravenously, the anticoagulant effect occurs immediately after injection. The drugs residence time depends on the administered dose and may range from 1–5 h. When injected subcutaneously, the anticoagulant effect occurs after 2–4 h [ 1 , 15 , 19 , 20 ].…”

“…Low molecular weight heparins are mainly used subcutaneously. After administration, the maximum anticoagulant effect occurs 2–3 h after administration and lasts up to 24 h [ 19 , 20 ].…”

Incidence, risk factors, and management of bleeding in patients receiving anticoagulants for the treatment of cancer-associated thrombosis

“…Overall, the rate of recurrent VTE was higher than the risk of bleeding and the benefit/risk ratio favored anticoagulant therapy. Numerous meta-analyses recently pooled the results of these studies (Table 1) [22][23][24][25]. Together, these RCTs included more than 2800 CAT patients treated with either DOAC or dalteparin.…”