Low-Molecular-Weight Heparin vs Heparin in the Treatment of Patients With Pulmonary Embolism

Hull, Russell D.; Raskob, Gary E.; Brant, Rollin; Pineo, Graham F.; Elliott, G B; Stein, Paul D.; Gottschalk, Alexander; Valentine, Karen; Mah, Andrew F.

doi:10.1001/archinte.160.2.229

Cited by 182 publications

(81 citation statements)

References 65 publications

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“…The cause of this difference remains unclear, although the mortality benefit of LMWH appears restricted to the subgroup of patients with VTE associated with malignancy. 29,30 Subsequent to publication of these meta-analyses, randomized trials confirmed that LMWH is at least as effective and safe as UFH for treatment of VTE, [31][32][33] and once-daily LMWH was as effective and safe as UFH for treatment of symptomatic PE. 34 The predictable anticoagulant response to weight-based LMWH allows for outpatient therapy of VTE.…”

Section: Comparative Efficacy and Safety Of Ufh And Lmwhmentioning

confidence: 99%

Initial Treatment of Venous Thromboembolism

McRae

Ginsberg

2004

Circulation

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Abstract-Adequate initial anticoagulant therapy of deep venous thrombosis (DVT) is required to prevent thrombus growth and pulmonary embolism (PE). Intravenous unfractionated heparin (UFH) is being replaced by low-molecular-weight heparin (LMWH) as the anticoagulant of choice for initial treatment of venous thromboembolism (VTE). Both agents are relatively safe and effective when used to treat VTE, with LMWH suitable for outpatient therapy because of improved bioavailability and more predictable anticoagulant response. Serious potential complications of heparin therapy, such as heparin-induced thrombocytopenia (HIT) and osteoporosis, seem less common with LMWH. The potential for fetal harm and changes in maternal physiology complicate the treatment of VTE during pregnancy. Although systemic thrombolysis is used in patients with massive PE and in some patients with proximal DVT, controversy persists with respect to appropriate patient selection for this intervention. Key Words: venous thromboembolism Ⅲ pulmonary embolism Ⅲ deep venous thrombosis Ⅲ anticoagulants Ⅲ thrombosis Ⅲ heparin

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Section: Comparative Efficacy and Safety Of Ufh And Lmwhmentioning

confidence: 99%

Initial Treatment of Venous Thromboembolism

McRae

Ginsberg

2004

Circulation

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“…12,13 Three other articles [14][15][16] had follow-up publications reporting the cancer subgroup data. [17][18][19][20] We contacted the authors of the remaining 19 articles to request cancer subgroup data: One author provided us with the data 21 ; another author indicated that the data were not available anymore 22 ; we used the cancer subgroup data for 7 articles, 23-29 because they were reported in 2 published systematic reviews 5,8 ; and we were not able to obtain any outcome data for the remaining studies. [30][31][32][33][34][35][36][37][38][39] Thus, of 24 studies with cancer patients' subgroups, we were able to obtain data for 13 studies.…”

Section: Data Synthesis and Analysismentioning

confidence: 99%

Anticoagulation for the initial treatment of venous thromboembolism in patients with cancer

Akl

Rohilla

Barba³

et al. 2008

Cancer

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BACKGROUND.The authors compared the relative efficacy and safety of low‐ molecular‐weight heparin (LMWH) and unfractionated heparin (UFH) for the initial treatment of venous thromboembolism (VTE) between patients with and without cancer.METHODS.By using Cochrane methodology for systematic reviews, separate meta‐analyses were conducted for subgroups of patients with and without cancer, and relative risks (RRs) were compared for statistical significance. The methodologic quality for each outcome was assessed by using the Grading of Recommendations Assessment, Development, and Evaluation approach.RESULTS.LMWH reduced mortality significantly compared with UFH in patients with cancer (RR of 0.71; 95% confidence interval [95% CI], 0.52‐0.98 [moderate‐quality evidence]) but not in patients without cancer (RR of 0.97; 95% CI, 0.65‐1.46 [low‐quality evidence]). However, the difference in the RR for the 2 subgroups did not reach statistical significance (P = .113). The difference between LMWH and UFH in the effect on recurrent VTE was not statistically significant in the subgroup with cancer (RR of 0.78; 95% CI, 0.29‐2.08 [low‐quality evidence]), in the subgroup without cancer (RR of 0.94; 95% CI, 0.60‐1.46 [low‐quality evidence]), or between the 2 subgroups (P = .367). No data were available for bleeding outcomes, thrombocytopenia, or postphlebitic syndrome.CONCLUSIONS.The current results indicated that LMWH most likely is superior to UFH in reducing mortality in the initial treatment of VTE for patients with cancer. There is a need for more and better designed trials to confirm these findings. Cancer 2008. © 2008 American Cancer Society.

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“…As HBPM têm substituído a heparina não fracionada por possuírem menos efeitos indesejáveis como a resposta variável devido à ligação com proteínas plasmáticas ou a trombocitopenia induzida pela heparina (TIH) [1]. Além disso, diversos estudos realizados com modelos de trombose venosa em animais e estudos clínicos em humanos portadores de doenças venosas tromboembólicas mostraram que as HBPM são equivalentes ou até mesmo superiores à heparina não fracionada em relação ao seu efeito antitrombótico e possuem maior segurança por apresentar menor risco hemorrágico [5,14,17,18,19,20,21,22].…”

Section: Antitrombóticosunclassified

Avaliação da tromboflebite jugular experimental em equinos tratados com heparina

Borghesan¹

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Low-Molecular-Weight Heparin vs Heparin in the Treatment of Patients With Pulmonary Embolism

Cited by 182 publications

References 65 publications

Initial Treatment of Venous Thromboembolism

Initial Treatment of Venous Thromboembolism

Anticoagulation for the initial treatment of venous thromboembolism in patients with cancer

Avaliação da tromboflebite jugular experimental em equinos tratados com heparina

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