Fixed combinations of low-molecular weight or unfractionated heparin plus dihydroergotamine in the prevention of postoperative deep vein thrombosis

Kakkar, Vijay V.; Stringer, Mark D.; Hedges, Anthony R.; Parker, Christopher J.; Welzel, D; Ward, V.; Sanderson, Ruth; Cooper, Derek; Kakkar, S.

doi:10.1016/0002-9610(89)90589-8

Cited by 37 publications

(9 citation statements)

References 25 publications

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“…31 Similarly, the association of dihydroergotamine to a LMWH was found to be as effective as UFH-dihydroergotamine. 32,33 Because of the large number of patients required to obtain reliable results for the prevention of pulmonary embolism, studies based on objective diagnostic tests to assess the value of LMWH for this purpose have not be done. However, a recent Italian multicenter, doubleblind trial, involving more than 4000 patients, has shown a significant reduction in overall mortality in patients receiving Fraxiparin (eight deaths) when compared with a placebo group (18 deaths).…”

Section: Results In General Surgerymentioning

confidence: 99%

“…21,22,45 In some of the studies carried out in general surgery with Fraxiparin, Kabi 2165, and the Sandoz heparin fraction, there was an increased bleeding tendency among treated patients when compared with control groups (Table 1). 24,29,30,33 Most of these hemorrhagic occurrences were considered minor. Statistically significant differences were seen in only two studies using Kabi 2165; it should be noted that in most of these patients the Kabi preparation was injected at the abdominal wall.…”

Section: Tolerance To Low Molecular Weight Heparinsmentioning

confidence: 99%

See 1 more Smart Citation

Low Molecular Weight Heparins and External Pneumatic Compression as Options for Venous Thromboembolism Prophylaxis: A Surgeon's Perspective

Caprini¹,

Arcelus²,

Traverso³

et al. 1991

Semin Thromb Hemost

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Section: Results In General Surgerymentioning

confidence: 99%

Section: Tolerance To Low Molecular Weight Heparinsmentioning

confidence: 99%

Low Molecular Weight Heparins and External Pneumatic Compression as Options for Venous Thromboembolism Prophylaxis: A Surgeon's Perspective

Caprini¹,

Arcelus²,

Traverso³

et al. 1991

Semin Thromb Hemost

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“…Thirty studies reported the effect of LMWH vs UFH on risk of mortality. 305,307,308,[310][311][312]314,[317][318][319]321,322,[325][326][327][329][330][331][332][333][334][335][336][337][338][339]341,342,346,347 Thirty-one studies reported the effect of LMWH vs UFH on development of symptomatic PEs, 295,[305][306][310][311][312][314][315][316][317][318][319]321,322,324,[326][327][328][329]…”

Section: Recommendation 17mentioning

confidence: 99%

American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients

et al. 2019

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Background:Venous thromboembolism (VTE) is a common source of perioperative morbidity and mortality.Objective:These evidence-based guidelines from the American Society of Hematology (ASH) intend to support decision making about preventing VTE in patients undergoing surgery.Methods:ASH formed a multidisciplinary guideline panel balanced to minimize bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline-development process, including performing systematic reviews. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment.Results:The panel agreed on 30 recommendations, including for major surgery in general (n = 8), orthopedic surgery (n = 7), major general surgery (n = 3), major neurosurgical procedures (n = 2), urological surgery (n = 4), cardiac surgery and major vascular surgery (n = 2), major trauma (n = 2), and major gynecological surgery (n = 2).Conclusions:For patients undergoing major surgery in general, the panel made conditional recommendations for mechanical prophylaxis over no prophylaxis, for pneumatic compression prophylaxis over graduated compression stockings, and against inferior vena cava filters. In patients undergoing total hip or total knee arthroplasty, conditional recommendations included using either aspirin or anticoagulants, as well as for a direct oral anticoagulant over low-molecular-weight heparin (LMWH). For major general surgery, the panel suggested pharmacological prophylaxis over no prophylaxis, using LMWH or unfractionated heparin. For major neurosurgery, transurethral resection of the prostate, or radical prostatectomy, the panel suggested against pharmacological prophylaxis. For major trauma surgery or major gynecological surgery, the panel suggested pharmacological prophylaxis over no prophylaxis.

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“…There were 17 general surgery clinical trials 12-28 also used by Jüni et al 3 for their assessment. We based our analysis on the same data set to allow comparability with Jüni et al 3 All original papers were retrieved for our analysis, including a paper in German 13 (which was translated) and five abstracts 12,16,19,24,29 of which three 19,21,30 have subsequently been published. Deep vein thrombosis (DVT) was chosen as the major end-point for our analysis.…”

Section: Data Descriptionmentioning

confidence: 99%

“…trial results for our analysis. Three studies 14,21,26 involved the use of dihydroergotamine mesylate (DHE) along with heparins in both the groups. In other studies 28,30 where more than one dose of LMWH or UFH were used, the more commonly prescribed dose or the dose comparable to other studies was chosen for analysis.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Stratification by quality induced selection bias in a meta-analysis of clinical trials

Stone

Gurunathan

Glass

et al. 2019

Journal of Clinical Epidemiology

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Objective: The inconsistency demonstrated across strata when using different scales has been attributed to quality scores and stratification continues to be done using risk of bias domain judgments. This study examines if restricting primary meta-analyses to studies at low risk of bias or presenting meta-analyses stratified according to risk of bias is indeed the right approach to explore potential methodological bias. Study Design and Setting: Re-analysis of quality subgroups in an existing meta-analysis based on 25 different scales Results: We demonstrate that quality stratification itself is the problem because it induces a spurious association between effect size and precision within stratum. Studies with larger effects or lesser precision tend to be of lower quality-a form of collider stratification bias (stratum being the common effect of the reasons for these two outcomes) that leads to inconsistent results across scales. We also show that the extent of this association determines the variability in effect size and statistical significance across strata when conditioning on quality. Conclusions: We conclude that stratification by quality leads to a form of selection bias (collider stratification bias) and should be avoided. We demonstrate consistent results with an alternative method that includes all studies.

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Fixed combinations of low-molecular weight or unfractionated heparin plus dihydroergotamine in the prevention of postoperative deep vein thrombosis

Cited by 37 publications

References 25 publications

Low Molecular Weight Heparins and External Pneumatic Compression as Options for Venous Thromboembolism Prophylaxis: A Surgeon's Perspective

Low Molecular Weight Heparins and External Pneumatic Compression as Options for Venous Thromboembolism Prophylaxis: A Surgeon's Perspective

American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients

Stratification by quality induced selection bias in a meta-analysis of clinical trials

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