Unfractionated heparin versus low molecular weight heparins for avoiding heparin-induced thrombocytopenia in postoperative patients

Abstract

This updated review demonstrated low-quality evidence of a lower incidence of HIT, and HIT complicated by venous thromboembolism, in postoperative patients undergoing thromboprophylaxis with LMWH compared with UFH. Similarily, the risk of HIT in people undergoing major surgical procedures was lower when treated with LMWH compared to UFH (low-quality evidence). The quality of the evidence was downgraded due to concerns about the risk of bias in the included studies and imprecision of the study results. These findings may support current clinical use of LMWH over UFH as front-line heparin therapy. However, our conclusions are limited and there was an unexpected paucity of RCTs including HIT as an outcome. To address the scarcity of clinically-relevant information on HIT, HIT must be included as a core harmful outcome in future RCTs of heparin.

Evaluation of unfractionated heparin versus low‐molecular‐weight heparin and fondaparinux for pharmacologic venous thromboembolic prophylaxis in critically ill patients with cancer

“…These data mirror data from elective surgery patients with cancer showing trends toward decreased rates of significant bleeding . The significant reduction in HIT found in our study is also similar to current data . Our study reinforces the findings from a variety of clinical settings that LMWH prophylaxis reduces the proportion of patients with a significant bleeding event when compared with UFH and has a reduced rate of HIT .…”

“…The significant reduction in HIT found in our study is also similar to current data . Our study reinforces the findings from a variety of clinical settings that LMWH prophylaxis reduces the proportion of patients with a significant bleeding event when compared with UFH and has a reduced rate of HIT . The significant reduction in bleeding may be because of the more consistent pharmacokinetic and dynamic properties demonstrated by LMWHs when compared with UFH .…”

Evaluation of unfractionated heparin versus low‐molecular‐weight heparin and fondaparinux for pharmacologic venous thromboembolic prophylaxis in critically ill patients with cancer

“…These data mirror data from elective surgery patients with cancer showing trends toward decreased rates of significant bleeding . The significant reduction in HIT found in our study is also similar to current data . Our study reinforces the findings from a variety of clinical settings that LMWH prophylaxis reduces the proportion of patients with a significant bleeding event when compared with UFH and has a reduced rate of HIT .…”

“…The significant reduction in HIT found in our study is also similar to current data . Our study reinforces the findings from a variety of clinical settings that LMWH prophylaxis reduces the proportion of patients with a significant bleeding event when compared with UFH and has a reduced rate of HIT . The significant reduction in bleeding may be because of the more consistent pharmacokinetic and dynamic properties demonstrated by LMWHs when compared with UFH .…”

Venous thromboembolism and anticoagulation in spinal cord lesion rehabilitation inpatients: A 10-year retrospective study

“…VTE and mortality percentages presented here are, respectively, compatible with rates described previously for persons with SCL or following surgery, who received preventive anticoagulation (Arnold et al, 2017; Junqueira et al, 2017), or for patients at elevated risk of VTE, who received preventive anticoagulation and who contracted PE (Bělohlávek et al, 2013; Klemen et al, 2020; Søgaard et al,2014).…”

A retrospective analysis of the frequency of heparin-induced thrombocytopenia in the intensive care unit at a tertiary care center in Riyadh, Saudi Arabia

“…The formation of heparin-platelet 4 complexes is responsible for HIT, and its most common association is with the use of UFH, a finding consistent with other studies [2,10,27,31,35]. However, our study did not reveal a statistically significant difference in HIT development between LMWH and UFH in both ICU (P = 0.249) and non-ICU patients (P = 0.221).…”

“…2.8%, respectively; P = 0.051) aligning with previous literature [27,31,32]. However, a metaanalysis indicated comparable rates of clinical HIT with both medications at therapeutic levels (UFH, 1.5% vs. LMWH, 1.2%) [33,34].…”

Evaluation of unfractionated heparin versus low‐molecular‐weight heparin and fondaparinux for pharmacologic venous thromboembolic prophylaxis in critically ill patients with cancer

“…These data mirror data from elective surgery patients with cancer showing trends toward decreased rates of significant bleeding . The significant reduction in HIT found in our study is also similar to current data . Our study reinforces the findings from a variety of clinical settings that LMWH prophylaxis reduces the proportion of patients with a significant bleeding event when compared with UFH and has a reduced rate of HIT .…”

“…The significant reduction in HIT found in our study is also similar to current data . Our study reinforces the findings from a variety of clinical settings that LMWH prophylaxis reduces the proportion of patients with a significant bleeding event when compared with UFH and has a reduced rate of HIT . The significant reduction in bleeding may be because of the more consistent pharmacokinetic and dynamic properties demonstrated by LMWHs when compared with UFH .…”

Venous thromboembolism and anticoagulation in spinal cord lesion rehabilitation inpatients: A 10-year retrospective study

“…VTE and mortality percentages presented here are, respectively, compatible with rates described previously for persons with SCL or following surgery, who received preventive anticoagulation (Arnold et al, 2017; Junqueira et al, 2017), or for patients at elevated risk of VTE, who received preventive anticoagulation and who contracted PE (Bělohlávek et al, 2013; Klemen et al, 2020; Søgaard et al,2014).…”

A retrospective analysis of the frequency of heparin-induced thrombocytopenia in the intensive care unit at a tertiary care center in Riyadh, Saudi Arabia

“…The formation of heparin-platelet 4 complexes is responsible for HIT, and its most common association is with the use of UFH, a finding consistent with other studies [2,10,27,31,35]. However, our study did not reveal a statistically significant difference in HIT development between LMWH and UFH in both ICU (P = 0.249) and non-ICU patients (P = 0.221).…”

“…2.8%, respectively; P = 0.051) aligning with previous literature [27,31,32]. However, a metaanalysis indicated comparable rates of clinical HIT with both medications at therapeutic levels (UFH, 1.5% vs. LMWH, 1.2%) [33,34].…”

Evaluation of unfractionated heparin versus low‐molecular‐weight heparin and fondaparinux for pharmacologic venous thromboembolic prophylaxis in critically ill patients with cancer

“…These data mirror data from elective surgery patients with cancer showing trends toward decreased rates of significant bleeding . The significant reduction in HIT found in our study is also similar to current data . Our study reinforces the findings from a variety of clinical settings that LMWH prophylaxis reduces the proportion of patients with a significant bleeding event when compared with UFH and has a reduced rate of HIT .…”

“…The significant reduction in HIT found in our study is also similar to current data . Our study reinforces the findings from a variety of clinical settings that LMWH prophylaxis reduces the proportion of patients with a significant bleeding event when compared with UFH and has a reduced rate of HIT . The significant reduction in bleeding may be because of the more consistent pharmacokinetic and dynamic properties demonstrated by LMWHs when compared with UFH .…”

Venous thromboembolism and anticoagulation in spinal cord lesion rehabilitation inpatients: A 10-year retrospective study

“…VTE and mortality percentages presented here are, respectively, compatible with rates described previously for persons with SCL or following surgery, who received preventive anticoagulation (Arnold et al, 2017; Junqueira et al, 2017), or for patients at elevated risk of VTE, who received preventive anticoagulation and who contracted PE (Bělohlávek et al, 2013; Klemen et al, 2020; Søgaard et al,2014).…”

A retrospective analysis of the frequency of heparin-induced thrombocytopenia in the intensive care unit at a tertiary care center in Riyadh, Saudi Arabia

“…The formation of heparin-platelet 4 complexes is responsible for HIT, and its most common association is with the use of UFH, a finding consistent with other studies [2,10,27,31,35]. However, our study did not reveal a statistically significant difference in HIT development between LMWH and UFH in both ICU (P = 0.249) and non-ICU patients (P = 0.221).…”

“…2.8%, respectively; P = 0.051) aligning with previous literature [27,31,32]. However, a metaanalysis indicated comparable rates of clinical HIT with both medications at therapeutic levels (UFH, 1.5% vs. LMWH, 1.2%) [33,34].…”