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Efficacy and safety of anticoagulant prophylaxis to prevent venous thromboembolism in acutely ill medical inpatients: a meta-analysis

Sjaelander, A.; Jansson, J. -H.; Bergqvist, D.; Eriksson, H.; Carlberg, B. and Svensson, Peter LU (2008) In Journal of Internal Medicine 263(1). p.52-60
Abstract
Objectives. Venous thromboembolism (VTE) is a potentially serious complication of hospitalization and immobilization. The use of anticoagulant prophylaxis in acutely ill medical inpatients is still under debate. New data including a recent meta-analysis have recently been published. We aim at studying the efficacy and safety of anticoagulant prophylaxis in acutely ill medical inpatients, and demonstrate differences between meta-analyses due to different data extraction from the heterogeneous studies included. Subjects. The Cochrane Library, MEDLINE and EMBASE were searched from 1980 to present. Manual searches were performed regarding abstracts from major meetings. Seven blinded randomized controlled clinical trials assessing the... (More)
Objectives. Venous thromboembolism (VTE) is a potentially serious complication of hospitalization and immobilization. The use of anticoagulant prophylaxis in acutely ill medical inpatients is still under debate. New data including a recent meta-analysis have recently been published. We aim at studying the efficacy and safety of anticoagulant prophylaxis in acutely ill medical inpatients, and demonstrate differences between meta-analyses due to different data extraction from the heterogeneous studies included. Subjects. The Cochrane Library, MEDLINE and EMBASE were searched from 1980 to present. Manual searches were performed regarding abstracts from major meetings. Seven blinded randomized controlled clinical trials assessing the prophylactic effect of heparin in acutely ill medical patients were identified and included in the meta-analysis. Results. Low-molecular weight heparin (LMWH) prophylaxis prevented 48% of symptomatic pulmonary embolism (PE), 48% of symptomatic deep vein thrombosis (DVT) (not significant) and 51% of asymptomatic DVT. A nonsignificant trend towards higher bleeding risk during LMWH prophylaxis was found. Death was not significantly affected. We compared our data with a recent meta-analysis with different study selection and data extraction and found similar results. Conclusions. As DVT and PE are manifestations of the same illness, VTE, one can argue that anticoagulant prophylaxis prevents approximately half of the expected events. Most medical inpatients have short hospital stays, and a low risk of VTE. The important task for the clinician is to identify patients with a sufficiently high risk of symptomatic VTE to warrant LMWH prophylaxis. Despite differences in study selection and data extraction, our study shows results similar to a recent meta-analysis. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
prevention, pulmonary embolism, venous thrombosis, venous thromboembolism, low-molecular weight heparin, heparin
in
Journal of Internal Medicine
volume
263
issue
1
pages
52 - 60
publisher
Wiley-Blackwell
external identifiers
  • wos:000251553800006
  • scopus:36949019341
ISSN
1365-2796
DOI
10.1111/j.1365-2796.2007.01878.x
language
English
LU publication?
yes
id
ac5d42b5-90a2-4139-8bc8-9ff286f8ac17 (old id 965872)
date added to LUP
2009-07-09 09:02:32
date last changed
2017-09-10 04:19:06
@article{ac5d42b5-90a2-4139-8bc8-9ff286f8ac17,
  abstract     = {Objectives. Venous thromboembolism (VTE) is a potentially serious complication of hospitalization and immobilization. The use of anticoagulant prophylaxis in acutely ill medical inpatients is still under debate. New data including a recent meta-analysis have recently been published. We aim at studying the efficacy and safety of anticoagulant prophylaxis in acutely ill medical inpatients, and demonstrate differences between meta-analyses due to different data extraction from the heterogeneous studies included. Subjects. The Cochrane Library, MEDLINE and EMBASE were searched from 1980 to present. Manual searches were performed regarding abstracts from major meetings. Seven blinded randomized controlled clinical trials assessing the prophylactic effect of heparin in acutely ill medical patients were identified and included in the meta-analysis. Results. Low-molecular weight heparin (LMWH) prophylaxis prevented 48% of symptomatic pulmonary embolism (PE), 48% of symptomatic deep vein thrombosis (DVT) (not significant) and 51% of asymptomatic DVT. A nonsignificant trend towards higher bleeding risk during LMWH prophylaxis was found. Death was not significantly affected. We compared our data with a recent meta-analysis with different study selection and data extraction and found similar results. Conclusions. As DVT and PE are manifestations of the same illness, VTE, one can argue that anticoagulant prophylaxis prevents approximately half of the expected events. Most medical inpatients have short hospital stays, and a low risk of VTE. The important task for the clinician is to identify patients with a sufficiently high risk of symptomatic VTE to warrant LMWH prophylaxis. Despite differences in study selection and data extraction, our study shows results similar to a recent meta-analysis.},
  author       = {Sjaelander, A. and Jansson, J. -H. and Bergqvist, D. and Eriksson, H. and Carlberg, B. and Svensson, Peter},
  issn         = {1365-2796},
  keyword      = {prevention,pulmonary embolism,venous thrombosis,venous thromboembolism,low-molecular weight heparin,heparin},
  language     = {eng},
  number       = {1},
  pages        = {52--60},
  publisher    = {Wiley-Blackwell},
  series       = {Journal of Internal Medicine},
  title        = {Efficacy and safety of anticoagulant prophylaxis to prevent venous thromboembolism in acutely ill medical inpatients: a meta-analysis},
  url          = {http://dx.doi.org/10.1111/j.1365-2796.2007.01878.x},
  volume       = {263},
  year         = {2008},
}