Comparison of the Efficacy and Safety of Low Molecular Weight Heparins for Venous Thromboembolism Prophylaxis in Medically Ill Patients.

Link to article at PubMed

Comparison of the Efficacy and Safety of Low Molecular Weight Heparins for Venous Thromboembolism Prophylaxis in Medically Ill Patients.

Curr Med Res Opin. 2013 Aug 23;

Authors: Dooley C, Kaur R, Sobieraj DM

Abstract
Abstract Objective: To conduct a systematic review and mixed-treatment comparison (MTC) meta-analysis to compare the efficacy and safety of low-molecular weight heparins LMWHs for venous thromboembolism (VTE) prophylaxis in hospitalized medically ill patients. As a secondary objective we compared all therapies within the network to each other. Methods: We conducted a systematic literature search for randomized trials that evaluated pharmacologic VTE prophylaxis in hospitalized medically ill patients. We conducted a traditional meta-analysis for all pairwise comparisons using a random effects model, reporting relative risks (RRs) and 95% confidence intervals for each outcome. To determine the relative efficacy and safety of included therapies we conducted a MTC meta-analysis using a Bayesian framework, reporting RRs and 95 percent credible intervals for each outcome. Results: Twenty trials met inclusion criteria.Enoxaparin, dalteparin, nadroparin and certoparin were the LMWH evaluated although none in direct comparative trials. Upon MTC, the relative efficacy of all LMWHs was similar in preventing morality and VTE and in the risk of major and minor bleeding Dalteparin was not included in the network to evaluate deep vein thrombosis (DVT) and pulmonary embolism (PE) due to lack of reported data and the remaining LMWHs were found to be similar in relative efficacy in preventing these outcomes. Limitations: Traditional meta-analysis was not possible for many drug comparisons made within the MTC. Heterogeneity was observed in several of the traditional meta-analyses although this may be an inherent limitation of the studied population. Overall rarity of events contributed to imprecise estimates demonstrated by the wide confidence intervals. Conclusions: Enoxaparin, dalteparin, nadroparin and certoparin are similar in relative efficacy for the prevention of mortality and VTE and in the risk of major or minor bleeding while enoxaparin, nadroparin and certoparin are similar in relative efficacy for the prevention of PE and DVT in hospitalized medical patients.

PMID: 23971722 [PubMed - as supplied by publisher]

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