Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism

Dongen, Carlo J van; Belt, Angelique GM van den; Prins, Martin H.; Lensing, A.W.A.

doi:10.1002/14651858.cd001100.pub2

Cited by 252 publications

(145 citation statements)

References 47 publications

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“…Clinical trials have established that LMWH is at least as safe and effective as unfractionated heparin in the treatment of VTE [40,41]. Moreover, two major RCTs have also established that the outpatient administration of LMWH is as safe as unfractionated heparin administered in hospital for the treatment of DVT [42][43][44].…”

Section: Discussionmentioning

confidence: 99%

Outpatient treatment and early discharge of symptomatic pulmonary embolism: a systematic review

Squizzato¹,

Galli²,

Dentali³

et al. 2009

Eur Respir J

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The published literature regarding the safety of outpatient treatment of symptomatic pulmonary embolism (PE) was systematically summarised.A literature search was performed using the PubMed and EMBASE databases. Studies in which patients had symptomatic PE and the antithrombotic treatment was administered completely at home or the patients were discharged early were selected. A scoring system was used to divide studies into three quality categories. Short-and long-term outcomes were extracted: all-cause mortality, death from PE or from major haemorrhage, recurrent venous thromboembolism, and major bleeding.Eleven observational studies were included. No randomised controlled studies were identified. No study fulfilled the criteria for high quality. A total of 928 patients with symptomatic PE were treated completely as outpatients or discharged early; haemodynamic instability and hypoxia were the main exclusion criteria. No patient died during the first 7 days of antithrombotic treatment.Outpatient treatment of symptomatic PE is not based on high-quality evidence. Although the published data suggest that certain subgroups of haemodynamically and respiratorily stable patients may be safely treated at home when a well-defined management programme is applied, further studies are warranted for a short-term prognostic risk stratification of this PE subgroup.

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Section: Discussionmentioning

confidence: 99%

Outpatient treatment and early discharge of symptomatic pulmonary embolism: a systematic review

Squizzato¹,

Galli²,

Dentali³

et al. 2009

Eur Respir J

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“…There is only indirect evidence in studies concerning extra cerebral thromboembolism, which have demonstrated that LMWH is a more efficient treatment with a safer profile and fewer complications. 66 Further research has to be undertaken to confirm this observation in patients with CVST. According to the most recent EFNS guidelines, 25 patients with CVST without any contraindications for antithrombotic treatment should be treated either with subcutaneous body-weightadjusted LMWH (180 antifactor Xa U/kg/24 hours administered using 2 subcutaneous injections daily) or with dose-adjusted intravenous heparin targeting twice the normal aPTT values.…”

Section: Treatmentmentioning

confidence: 90%

Cerebral venous sinus thrombosis: review of the demographics, pathophysiology, current diagnosis, and treatment

Filippidis¹,

Kapsalaki

Patramani

et al. 2009

FOC

120

160

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Cerebral venous sinus thrombosis (CVST) is a rare clinicopathological entity. The incidence of CVST in children and neonates has been reported to be as high as 7 cases per million people, whereas in adults the incidence is 3–4 cases per million. The predisposing factors to this condition are mainly genetic and acquired prothrombotic states and infection. The clinical picture of CVST is nonspecific, highly variable, and can mimic several other clinical conditions. Diagnosis of CVST is established with the implementation of neuroimaging studies, especially MR imaging and venography. Identification and elimination of the underlying cause, anticoagulation, proper management of intracranial hypertension, and anticonvulsant prophylaxis constitute cornerstones of CVST treatment. Newer treatment strategies such as endovascular thrombolysis and decompressive craniectomy have been recently used in the treatment of patients with CVST with variable success rates. Further clinical research must be performed to delineate the exact role of these newer treatments in the management of severe cases of CVST. The recent advances in the diagnosis and treatment of patients with CVST have significantly lowered the associated mortality and morbidity and have improved the outcome of these patients.

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“…The results have been summarised in a meta-analysis with pooled data from 7124 patients: major haemorrhage occurred in 41 (1.2%) out of 3500 patients treated with LMWH compared with 73 (2.0%) out of 3624 patients treated with UFH (OR 0.57, 95% CI 0.39-0.83), thus suggesting that LMWH may reduce the occurrence of major bleeding during initial treatment compared with UFH (table 1), with equal efficacy in preventing recurrent VTE [18].…”

Section: Risk Of Bleedingmentioning

confidence: 99%

Predicting anticoagulant-related bleeding in patients with venous thromboembolism: a clinically oriented review

et al. 2014

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Diagnosis of venous thromboembolism (VTE) requires prompt treatment with anticoagulants in therapeutic doses. Since these drugs are associated with the occurrence of haemorrhage, identification of patients at increased risk of major bleeding is of utmost clinical importance for defining the optimal treatment regimen and duration of anticoagulation. Current suggested prediction scores for bleeding risk in VTE patients have been derived from observational studies of moderate quality, or from patients with various indications for therapeutic anticoagulation other than VTE. To date, none of the scores have been adequately validated in cohorts that underwent dedicated monitoring and independent adjudication of bleeding complications. In addition, while the scarce available evidence has focused on patients treated with heparins and/or vitamin K antagonists, risk stratification scores for bleeding complications in VTE patients treated with non-vitamin K dependent anticoagulants have not yet been developed. This clinically oriented review covers the incidence and risk factors of anticoagulation-related bleeding in VTE patients treated with different anticoagulant drugs as well as the available bleedingprediction scores. Further, we attempt to provide guidance for bleeding-prevention in clinical practice and speculate on developments in the near future that may fundamentally change our current thinking on VTE management. @ERSpublications Bleeding in VTE: no validated risk-prediction scores, no effective preventive measures: are NOACs the solution?

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Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism

Cited by 252 publications

References 47 publications

Outpatient treatment and early discharge of symptomatic pulmonary embolism: a systematic review

Outpatient treatment and early discharge of symptomatic pulmonary embolism: a systematic review

Cerebral venous sinus thrombosis: review of the demographics, pathophysiology, current diagnosis, and treatment

Predicting anticoagulant-related bleeding in patients with venous thromboembolism: a clinically oriented review

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