Estudio multicéntrico, prospectivo, de comparación del tratamiento de la tromboembolia pulmonar submasiva con enoxaparina y heparina no fraccionada

Llano, Luis Alejandro Pérez de; Villar, Adolfo Baloira; Racamonde, A. Veres; Veiga, Francisco José; Gómez, R. Golpe; Fernández, F. Pajuelo

doi:10.1016/s0300-2896(03)75401-5

Cited by 11 publications

(4 citation statements)

References 18 publications

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“…The mean incidence of bleeding events were lower in VTE (1.1% with LMWH and 1.9% with UFH), compared to ACS (5.8% with LMWH and 5.4% with UFH). Considering the efficacy end-points, 15 studies showed that LMWH were superior to UFH [12]; [15]; [17]–[19]; [21]–[23]; [26]; [27]; [29]; [30]; [36]; [40]; [42], 1 study showed that UFH was superior to LMWH [46], while the remaining 21 showed that there was no statistically significant difference between the two treatments [11]; [13]; [14]; [16]; [20]; [24]; [25]; [28]; [31]–[35]; [37]–[39]; [41]; [43]–[45]; [47].…”

Section: Resultsmentioning

confidence: 99%

“…As a consequence, in our review all the studies reporting haemorrhagic events, irrespective of the efficacy endpoint that was reported, have been included. As a consequence, compared to the Cochrane meta-analysis, 9 additional studies were included in our descriptive analysis [19]; [23]; [30]; [31]; [33]; [41]; [43]; [46]; [47], 6 of which were also included in our meta-analysis [31]; [33]; [41]; [43]; [46]; [47]. These additional studies account for 1344 more VTE patients included in our analysis.…”

Section: Discussionmentioning

confidence: 99%

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Bleeding Risk during Treatment of Acute Thrombotic Events with Subcutaneous LMWH Compared to Intravenous Unfractionated Heparin; A Systematic Review

et al. 2012

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BackgroundLow Molecular Weight Heparins (LMWH) are at least as effective antithrombotic drugs as Unfractionated Heparin (UFH). However, it is still unclear whether the safety profiles of LMWH and UFH differ. We performed a systematic review to compare the bleeding risk of fixed dose subcutaneous LMWH and adjusted dose UFH for treatment of venous thromboembolism (VTE) or acute coronary syndromes (ACS). Major bleeding was the primary end point.MethodsElectronic databases (MEDLINE, EMBASE, and the Cochrane Library) were searched up to May 2010 with no language restrictions. Randomized controlled trials in which subcutaneous LMWH were compared to intravenous UFH for the treatment of acute thrombotic events were selected. Two reviewers independently screened studies and extracted data on study design, study quality, incidence of major bleeding, patients’ characteristics, type, dose and number of daily administrations of LMWH, co-treatments, study end points and efficacy outcome. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using the random effects model.ResultsTwenty-seven studies were included. A total of 14,002 patients received UFH and 14,635 patients LMWH. Overall, no difference in major bleeding was observed between LMWH patients and UFH (OR = 0.79, 95% CI 0.60–1.04). In patients with VTE LMWH appeared safer than UFH, (OR = 0.68, 95% CI 0.47–1.00).ConclusionThe results of our systematic review suggest that the use of LMWH in the treatment of VTE might be associated with a reduction in major bleeding compared with UFH. The choice of which heparin to use to minimize bleeding risk must be based on the single patient, taking into account the bleeding profile of different heparins in different settings.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bleeding Risk during Treatment of Acute Thrombotic Events with Subcutaneous LMWH Compared to Intravenous Unfractionated Heparin; A Systematic Review

et al. 2012

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“…This practice is supported by many earlier studies and meta-analysis that showed equal efficacy of LMWH and UFH in the management of PE. [252627] In addition, LMWH has the advantage of not requiring monitoring, easy administration and lower incidence of heparin induced thrombocytopenia and this is in accordance with the guidelines of the European Society of Cardiology. [25] However, we noted with much interest that patients who died were more likely to have received UFH than those who survived.…”

Section: Discussionmentioning

confidence: 75%

“…This can be attributed to the fact that these patients were unstable and up to date, there are no studies supporting the use of LMWH in this group of high risk PE. [252627]…”

Section: Discussionmentioning

confidence: 99%

Outcome of pulmonary embolism and clinico-radiological predictors of mortality: Experience from a university hospital in Saudi Arabia

et al. 2014

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OBJECTIVES:The objective of this study is to determine the outcome of pulmonary embolism (PE) and the clinico-radiological predictors of mortality in a university hospital setting.METHODS:A Prospective observational study conducted at King Khalid University Hospital, Riyadh Saudi Arabia between January 2009 and 2012. A total of 105 consecutive patients (49.9 ± 18.7 years) with PE diagnosed by computed tomography pulmonary angiography were followed until death or hospital discharge.RESULTS:Overall in hospital mortality rate was 8.6%, which is lower than other international reports. Two-thirds of patients developed PE during the hospitalization. The most common risk factors were surgery (35.2%), obesity (34.3%) and immobility (30.5%). The localization of the embolus was central in 32.4%, lobar in 19% and distal in 48.6%. A total of 26 patients (25%) had evidence of right ventricular strain and 14 (13.3%) were hypotensive. Multivariate analysis revealed that heart failure (Beta = −0.53, P < 0.001), palpitation (Beta = −0.24, P = 0.014) and high respiratory rate (Beta = −0.211, P < 0.036) were significant predictors of mortality.There was no significant difference in the localization of the embolus or obstruction score between survivors and non-survivors.CONCLUSION:The outcome of PE is improving; however, it remains an important risk factor for mortality in hospitalized patients. Congestive heart failure, tachypnea and tachycardia at presentation were associated with higher mortality. These factors need to be considered for risk stratification and management decisions of PE patients. Radiological quantification of clot burden was not a predictor of death.

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Clinical and Safety Outcomes Associated With Treatment of Acute Venous Thromboembolism

Castellucci

Cameron

Gal

et al. 2014

JAMA

135

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Using meta-analytic pooling, there were no statistically significant differences for efficacy and safety associated with most treatment strategies used to treat acute venous thromboembolism compared with the LMWH-vitamin K antagonist combination. However, findings suggest that the UFH-vitamin K antagonist combination is associated with the least effective strategy and that rivaroxaban and apixaban may be associated with the lowest risk for bleeding.

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Estudio multicéntrico, prospectivo, de comparación del tratamiento de la tromboembolia pulmonar submasiva con enoxaparina y heparina no fraccionada

Cited by 11 publications

References 18 publications

Bleeding Risk during Treatment of Acute Thrombotic Events with Subcutaneous LMWH Compared to Intravenous Unfractionated Heparin; A Systematic Review

Bleeding Risk during Treatment of Acute Thrombotic Events with Subcutaneous LMWH Compared to Intravenous Unfractionated Heparin; A Systematic Review

Outcome of pulmonary embolism and clinico-radiological predictors of mortality: Experience from a university hospital in Saudi Arabia

Clinical and Safety Outcomes Associated With Treatment of Acute Venous Thromboembolism

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