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Evidence summaries

Heparin for the Prevention of Venous Thromboembolism in General Medical Patients (Excluding Stroke and Myocardial Infarction)

Heparin thromboprophylaxis (low molecular weight heparin, LMWH and unfractionated heparin, UFH) reduces the risk of both deep vein thrombosis and pulmonary embolism in patients with an acute medical illness. The risk of major bleeding is less with LMWH compared with UFH. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 16 studies with a total of 34 369 gwith an acute medical illness were included in this review. A significant risk reduction in deep vein thrombosis (DVT) (RR 0.41, 95% CI 0.25 to 0.67) and non-fatal pulmonary embolism (PE) (RR 0.46, 95% CI 0.20 to 1.07) and fatal PE (OR 0.71; 95% CI 0.43 to 1.15; P = 0.16) and in combined non-fatal PE and fatal PE (OR 0.66, 95% CI 0.43 to 1.02; P = 0.06). However, heparin resulted in a significant increase in major haemorrhage (RR 1.65, 95% CI 1.01 to 2.71). There was no clear evidence that heparin had an effect on all-cause mortality and thrombocytopaenia. Compared with UFH, LMWH reduced the risk of DVT (OR 0.77; 95% CI 0.62 to 0.96; P = 0.02) and major bleeding (OR 0.43; 95% CI 0.22 to 0.83; P = 0.01). There was no clear evidence that the effects of LMWH and UFH differed for the PE outcomes, all-cause mortality and thrombocytopaenia.

    References

    • Alikhan R, Bedenis R, Cohen AT. Heparin for the prevention of venous thromboembolism in acutely ill medical patients (excluding stroke and myocardial infarction). Cochrane Database Syst Rev 2014;(5):CD003747. [PubMed]

Primary/Secondary Keywords