Low Molecular Weight Versus Standard Heparin for Prevention of Venous Thromboembolism After Major Abdominal Surgery

Kakkar, Vijay V.; Cohen, A.T.; Edmonson, R.A.; Phillips, M. J.; Cooper, Derek; Das, Sunit; Mahler, K; Sanderson, Ruth; Ward, V.; Kakkar, S.

doi:10.1097/00132586-199310000-00031

Cited by 43 publications

(47 citation statements)

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“…However the studies have been too small to reliably comment on perioperative or post‐operative bleeding complications. One randomised controlled trial specifically assessed complications following the use of both types of heparin 16 . Although the primary outcome measure of total bleeding events failed to reach statistical significance ( P = 0.058), low molecular weight heparin had clear advantages in sub‐group analysis: reductions in re‐operation (RR 0.55, 95% CI 0.31‐0.98) and minor bleeding episodes (RR 0.78, 95% CI 0.29‐0.89).…”

Section: Discussionmentioning

confidence: 99%

A randomised double‐blind placebo controlled trial of low molecular weight heparin as prophylaxis in preventing venous thrombolic events after caesarean section: a pilot study

Burrows

Gan

Gallus

et al. 2001

BJOG

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Objective To pilot a protocol for a national multicentre randomised trial in which a low molecular weight heparin will be compared with placebo for prevention of venous thrombotic events occurring within six weeks after caesarean section.Design Double-blind randomised controlled trial. Setting Tertiary care centre.Participants Seventy-six women having had a caesarean section, 37 in the control group and 39 in the Dalteparin group.Methods Consenting patients having had an emergency or elective caesarean section were commenced on study medication 6±24 hours post-operatively. The study medication, dalteparin 2500iu or saline, was given subcutaneously once daily for four or ®ve days post-operatively depending on the patient's length of stay. Patients were reviewed in hospital for operative outcomes and contacted at two and six weeks post-operatively. Results Of the 141 women given information about the trial, 76 (54%) consented to participate. Follow up to six weeks was achieved in all women who were recruited. More women in the placebo arm had general anaesthesia, but otherwise the two groups had similar characteristics at randomisation. There was only one occurrence of a deep vein thrombosis during the study. This patient was in the treatment arm and the thrombosis occurred between two and six weeks post-operatively. All other outcomes were similar in the two groups. Conclusion Our experience of a 26% recruitment rate, the thrombosis rate of 1.3% (95% CI 0.03-7.1%) and the contactability of all participants two and six weeks post-operatively, indicates that this study is feasible.

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Section: Discussionmentioning

confidence: 99%

A randomised double‐blind placebo controlled trial of low molecular weight heparin as prophylaxis in preventing venous thrombolic events after caesarean section: a pilot study

Burrows

Gan

Gallus

et al. 2001

BJOG

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“…And yet, there is no consensus opinion on optimum management of such patients. Some investigators even consider thromboembolic risk following general surgery or orthopedic surgery to be negligible (26)(27)(28)(29)(30).…”

Section: Invited Editorialmentioning

confidence: 99%

“…A recent comment by Kakkar (26) should also be kept in mind: &dquo;Is it wise to extend prophylactic therapy to all my 3,358 patients who underwent abdominal surgery to prevent the death of 3 seriously or critically-ill ones from PE?&dquo; Nevertheless, no patient at risk for venous thromboembolism should be left unprotected (69), taking into account the risks inherent in anticoagulant treatment (26). Since to date no consensus exists, it is important to continue these investigations, as shown by the many related studies presented at the recent XV ISTH meeting in Jerusalem (1995).…”

Section: In 1996?mentioning

confidence: 99%

Optimal Duration for Prophylaxis of Deep Vein Thrombosis: The New Focus?

Toulemonde¹,

Kher²

1996

Clin Appl Thromb Hemost

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“…As always with meta‐analysis, there is the potential for publication bias, and although a useful tool, it is no substitute for a large scale clinical trial using direct comparison in a randomised controlled study. Such a trial has recently been reported (Kakkar et al 1993). This multicentre, randomised, double‐blind study compared subcutaneous injection of 2500 i.u.…”

mentioning

confidence: 94%

Low molecular weight heparin for obstetric thromboprophylaxis

Nelson‐Piercy

1994

BJOG

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Low Molecular Weight Versus Standard Heparin for Prevention of Venous Thromboembolism After Major Abdominal Surgery

Cited by 43 publications

References 0 publications

A randomised double‐blind placebo controlled trial of low molecular weight heparin as prophylaxis in preventing venous thrombolic events after caesarean section: a pilot study

A randomised double‐blind placebo controlled trial of low molecular weight heparin as prophylaxis in preventing venous thrombolic events after caesarean section: a pilot study

Optimal Duration for Prophylaxis of Deep Vein Thrombosis: The New Focus?

Low molecular weight heparin for obstetric thromboprophylaxis

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