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Evidence summaries

Once Versus Twice Daily Low Molecular Weight Heparin for the Initial Treatment of Venous Thromboembolism

Once daily administration of low molecular weight heparin (LMWH) for the initial treatment of venous thromboembolism appears to be as safe and effective as a twice daily regimen. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 5 studies with a total of 1 508 patients. One of the five included studies included people with pulmonary embolism (PE) and deep vein thrombosis (DVT), the other 4 studies included only people with DVT. The 5 included studies used 4 brands of low molecular weight heparin (LMWH) (enoxaparin, tinzaparin, dalteparin and nadroparin). The pooled data showed no difference in recurrent venous thromboembolism (OR 0.82, 95% CI 0.49 to 1.39; 3 studies, n=1 281) or extension of thrombus size (OR 1.41, 95% CI 0.66 to 3.01; 2 studies, n=107) between once versus twice daily LMWH for the initial treatment of venous thromboembolism. There were no significant differences in major haemorrhagic events (OR 0.77, 95% CI 0.40 to 1.45; 5 studies, n=1 508) and mortality (OR 1.14; 95% CI 0.62 to 2.08; 4 studies, n=1 421) between the two treatment regimens. None of the 5 included studies reported data on post-thrombotic syndrome.

Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment).

    References

    • Bhutia S, Wong PF. Once versus twice daily low molecular weight heparin for the initial treatment of venous thromboembolism. Cochrane Database Syst Rev 2013;(7):CD003074. [PubMed]

Primary/Secondary Keywords