Low Molecular Weight Heparin and Unfractionated Heparin in Thrombosis Prophylaxis: Meta-Analysis Based on Original Patient Data

Koch, Armin; Ziegler, Suzanne; Breitschwerdt, Heike; Victor, N.

doi:10.1016/s0049-3848(01)00251-1

Cited by 96 publications

(58 citation statements)

References 14 publications

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“…In use for nearly 40 years, numerous studies have documented the benefits of subcutaneous heparin for VTE prophylaxis, particularly after general and orthopedic surgery, with meta-analyses estimating a reduction in postoperative DVT and PE by 40% to 70%. 1,11 More recent experience has also been favorable with the use of LMWH 12 and the factor Xa inhibitor fondaparinux for postoperative chemical VTE prophylaxis. 13 Alternatively, mechanical preventative therapies such as TED stockings or SCDs may be used for the reduction of perioperative VTE.…”

Section: Discussionmentioning

confidence: 99%

“…1 Chemical prophylaxis, including the use of subcutaneous unfractionated heparin or low-molecular-weight heparin (LMWH), is one of the most commonly used postoperative VTE preventative measures after noncardiac surgery, reducing the risk of DVT and PE by 40% to 70% in clinical trials. 1,11,12 Fondaparinux, a factor Xa inhibitor, is another option now available for chemical VTE prophylaxis, with favorable experience reported after orthopedic operations. 13 Mechanical preventative therapies, such as graduated compression thromboembolic deterrent (TED)…”

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confidence: 99%

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Comparative Effectiveness of Preventative Therapy for Venous Thromboembolism After Coronary Artery Bypass Graft Surgery

Kulik

Rassen

Myers

et al. 2012

Circ: Cardiovascular Interventions

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Background-Controversy exists regarding the optimal preventative therapy for venous thromboembolism (VTE) after coronary artery bypass graft (CABG) surgery. We sought to compare the effectiveness and safety of the most commonly used regimens. Methods and Results-We assembled a cohort of 92 699 patients who underwent CABG between 2004 and 2008, using the Premier database. Patients were categorized by method of VTE prevention initiated within 48 hours of surgery, including no preventative therapy (n=55 400), mechanical preventative therapy (n=21 162), subcutaneous unfractionated or low-molecular-weight heparin (n=10 718), subcutaneous fondaparinux (n=88), and concurrent mechanicalchemical therapy (n=5331). The incidence of VTE and major bleeding events within 6 weeks of CABG were compared, using multivariable and propensity score adjustment. The overall incidence of VTE for the entire cohort was 0.74%, and the incidence of major bleeding was 1.43%. VTE and bleeding events occurred with similar incidence in each of the patient categories (VTE: 0.70%, 0.79%, 0.81%, 1.14%, and 0.73%; major bleeding: 1.36%, 1.45%, 1.69%, 3.41%, 1.50%; no prevention, mechanical prevention, subcutaneous heparin, subcutaneous fondaparinux, concurrent mechanical-chemical prevention, respectively). Compared with receiving no prevention, the use of mechanical prevention or subcutaneous heparin did not significantly reduce the risk of VTE or change the risk of major bleeding (P=NS). Conclusions-Venous thromboembolism occurs infrequently after CABG. Compared with the use of no prevention, the administration of chemical or mechanical preventative therapies to CABG patients does not appreciably lower the risk of VTE. These data provide support for the common practice of administering no VTE preventative therapy after CABG, used for nearly 60% of patients within this cohort. (Circ Cardiovasc Interv. 2012;5:590-596.)

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Comparative Effectiveness of Preventative Therapy for Venous Thromboembolism After Coronary Artery Bypass Graft Surgery

Kulik

Rassen

Myers

et al. 2012

Circ: Cardiovascular Interventions

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“…Table 2 Documented adverse affects with no significant differences between the low molecular weight heparin (LMWH) and rivaroxaban cohorts Extensive evidence exists supporting the efficacy of LMWH in VTE prophylaxis following lower limb joint arthroplasty; however, logistical and medical concerns exist regarding its use for an extended period of 28-35 days. [23][24][25] Furthermore, heparin-induced thrombocytopenia (HIT) is a known complication of LMWH use and guidelines recommend that all patients should be monitored for this potentially fatal condition. 26,27 However, recent evidence shows few patients are monitored for HIT and indeed very few orthopaedic surgeons are aware of the relevant guidelines.…”

Section: Discussionmentioning

confidence: 99%

Is there adequate provision of venous thrombo-embolism prophylaxis following hip arthroplasty? An audit and international survey

Rogers

Phillips

Foote

et al. 2010

annals

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INTRODUCTIONThe peak incidence of venous thrombo-embolism (VTE) occurs 3 weeks following hip arthroplasty surgery and current guidelines proposing VTE prophylaxis continuing for 4 weeks after surgery. This study first compares the duration of treatment and satisfaction between patients prescribed low molecular weight heparin (LMWH) and rivaroxaban, a new oral Factor Xa inhibitor, following elective hip arthroplasty; and second, surveys the duration of LMWH use in other units. SUBJECTS AND METHODS An international survey detailing the use of LMWH was performed. A prospective audit was performed of 100 hip replacements, with 50 prescribed 40 mg once daily of subcutaneous enoxaparin and subsequently 50 patients prescribed 10 mg once daily of oral rivaroxaban. The duration of treatment, patient satisfaction and complications for both cohorts was quantified and compared against published evidence-based guidelines. RESULTS The survey demonstrated that four out of 39 (10.2%) units that routinely prescribe LMWH do so for at least 4 weeks following surgery. The audit demonstrated that rivaroxaban afforded a superior mean duration of postoperative VTE prophylaxis (35 days vs 5.4 days; P < 0.05) and superior patient satisfaction. There was no difference in the incidence of bleeding, wound infection or thrombotic complications. CONCLUSIONS This study demonstrates that patients are exposed to an increased VTE risk following hip replacement surgery due to the inadequate prescription of LMWH. This is poor clinical practice, contrary to current evidence-based guidelines and has potential medicolegal implications. The prescription of rivaroxaban affords a superior patient compliance compared with subcutaneous LMWH, thus ensuring that patients receive VTE prophylaxis for the current recommend period of time.

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“…6 In patients undergoing surgery for cancer, prophylactic doses Ͼ3400 anti-Xa units of LMWH provide greater protection than lower doses. 7 Graduated compression stockings effectively reduce the risk for VTE in patients undergoing general surgery and constitute the prophylactic measure of choice in patients with a high risk of bleeding. A systematic review showed a 52% relative risk reduction with graduated compression stockings in comparison with no prophylaxis.…”

Section: General Surgerymentioning

confidence: 99%

Prevention of Venous Thromboembolism in Surgical Patients

2004

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Abstract-Venous thromboembolism (VTE) is a common complication of surgical procedures. The risk for VTE in surgical patients is determined by the combination of individual predisposing factors and the specific type of surgery. Prophylaxis with mechanical and pharmacological methods has been shown to be effective and safe in most types of surgery and should be routinely implemented. For patients undergoing general, gynecologic, vascular, and major urologic surgery, low-dose unfractionated heparin or low-molecular-weight heparin (LMWH) are the options of choice. For low-risk urologic surgery, early postoperative mobilization of patients is the only intervention warranted. For higher-risk patients, including those undergoing elective hip or knee replacement and surgery for hip fracture, vitamin K antagonists, LMWH, or fondaparinux are recommended. For patients undergoing neurosurgery, graduated elastic stockings are effective and safe and may be combined with LMWH to further reduce the risk of VTE. The role of prophylaxis is less defined in patients undergoing elective spine surgery, as well as laparoscopic and arthroscopic surgery. A number of issues related to prophylaxis of VTE after surgery deserve further clarification, including the role of screening for asymptomatic deep vein thrombosis, the best timing for initiation of pharmacological prophylaxis, and the optimal duration of prophylaxis in high-risk patients. Key Words: venous thromboembolism Ⅲ deep vein thrombosis Ⅲ pulmonary embolism Ⅲ heparin Ⅲ low-molecular-weight heparin Ⅲ vitamin K antagonists

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Low Molecular Weight Heparin and Unfractionated Heparin in Thrombosis Prophylaxis: Meta-Analysis Based on Original Patient Data

Cited by 96 publications

References 14 publications

Comparative Effectiveness of Preventative Therapy for Venous Thromboembolism After Coronary Artery Bypass Graft Surgery

Comparative Effectiveness of Preventative Therapy for Venous Thromboembolism After Coronary Artery Bypass Graft Surgery

Is there adequate provision of venous thrombo-embolism prophylaxis following hip arthroplasty? An audit and international survey

Prevention of Venous Thromboembolism in Surgical Patients

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