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Medicina Interna

Meta-analysis: prophylaxis of VTE in hospitalised medical patients

Arch Intern Med 2007; 167: 1476-86

Texto completo: http://archinte.ama-assn.org/cgi/content/abstract/167/14/1476

Both unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) reduce the risk of venous thromboembolism (VTE) in hospitalised medical patients, according to this meta-analysis, however neither seems to reduce mortality. The authors note that VTE is a significant cause of morbidity and mortality in hospitalised medical patients, and that while UFH, LMWH, and selective factor Xa inhibitors are used for prophylaxis it is uncertain which, if any, is superior. They carried out this study to clarify the issue.

They searched a range of sources for randomized controlled trials that involved medical patients, comparing unfractionated heparin (UFH) or low-molecular-weight heparin or heparinoid (LMWH) with a control, LMWH with UFH, or selective factor Xa inhibitors with a comparator. Outcome measures included a range of VTE events - any clinical outcome that was included in three or more studies was analysed.

The search identified 936 potentially relevant trials, reduced to 36 eligible studies including four different comparisons: UFH with control (n=14), LMWH with control (n=11), UFH with LMWH (n=10) and fondaparinux with control (n=1). Pooled analysis showed that both UFH and LMWH were superior to control in reducing VTE events including deep vein thrombosis (DVT) and pulmonary embolism (PE). Neither significantly reduced mortality. In direct comparison, LMWH was superior to UFH in preventing DVT and was associated with a lower incidence of injection-site bleeding; there was no significant difference between the two in PE, bleeding or thrombocytopenia. Fondaparinux was better than control in reducing VTE events, with a similar rate of major bleeding as control.

The authors conclude that their analysis shows both UFH and LMWH to be effective in reducing risk of VTE events in hospitalised medical patients, and when directly compared, LMWH is better than UFH in reducing risk of DVT. Neither reduces mortality. They suggest that VTE prophylaxis should become routine in appropriate medical patients: although this may not reduce mortality, it would reduce the burden of illness caused by VTE and PE.

BIBLIOTECA HOSPITALARQUITECTO MARCIDE