Low molecular weight heparin in prevention of perioperative thrombosis.

Abstract:

OBJECTIVE:To determine whether prophylactic treatment with low molecular weight heparin reduces the incidence of thrombosis in patients who have had general or orthopaedic surgery. DESIGN:Meta-analysis of results from 52 randomised, controlled clinical studies (29 in general surgery and 23 in orthopaedic surgery) in which low molecular weight heparin was compared with placebo, dextran, or unfractionated heparin. SUBJECTS:Patients who had had general or orthopaedic surgery. INTERVENTION:Once daily injection of a low molecular weight heparin compared with placebo, dextran, or unfractionated heparin. MAIN OUTCOME MEASURES:Incidence of deep venous thrombosis, pulmonary embolism, major haemorrhages, and death. RESULTS:The results confirm that low molecular weight heparins are more efficacious for the prophylactic treatment of deep venous thrombosis than placebo (common odds ratio 0.31, 95% confidence interval 0.22 to 0.43; p < 0.001) and dextran (0.44, 0.30 to 0.65; p < 0.001). The results suggest that low molecular weight heparins are also more efficacious than unfractionated heparin (0.85, 0.74 to 0.97; p = 0.02), with no significant difference in the incidence of major haemorrhages (1.06, 0.93 to 1.20; p = 0.62). CONCLUSIONS:Low molecular weight heparins seem to have a higher benefit to risk ratio than unfractionated heparin in preventing perioperative thrombosis. However, it remains to be shown in a suitably powered clinical trial whether low molecular weight heparin reduces the risk of fatal pulmonary embolism compared with heparin.

journal_name

BMJ

authors

Leizorovicz A,Haugh MC,Chapuis FR,Samama MM,Boissel JP

doi

10.1136/bmj.305.6859.913

keywords:

subject

Has Abstract

pub_date

1992-10-17 00:00:00

pages

913-20

issue

6859

eissn

0959-8138

issn

1756-1833

journal_volume

305

pub_type

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