Ken Uchino, MD
In patients with ischemic stroke, does low-molecular-weight heparin (LMWH) prevent venous thromboembolism (VTE) more than unfractionated heparin (UFH)?
Studies selected compared LWMH with UFH for VTE prophylaxis in patients with ischemic stroke. Trials were excluded if they compared heparin with placebo; if heparin was administered as part of stroke management and not specifically for VTE prevention; and if VTE was not the primary endpoint. Outcomes were overall VTE, proximal VTE, and pulmonary embolism (PE). Other outcomes included bleeding (intracerebral and extracranial) and mortality.
MEDLINE (1966 to April 2006), EMBASE/Excerpta Medica (1990 to April 2006), Cochrane Library, clinicaltrials.gov, annual meetings abstracts, and reference lists were searched for randomized controlled trials (RCTs); experts were contacted. 3 RCTs met the selection criteria (n = 2028): 2 used enoxaparin, 40 mg/d, and 1 used certoparin, 3000 IU/d. All studies used UFH, 5000 IU, administered 3 times/d in 2 studies and twice daily in 1 study. LMWH and UFH were administered ≤ 48 h after stroke onset. Study quality was high (median Jadad score = 6).
Meta-analysis showed that LMWH reduced overall VTE, proximal VTE, and PE more than UFH (Table). LMWH and UFH did not differ for safety outcomes (Table).
Low-molecular-weight heparin reduces venous thromboembolism more than unfractionated heparin after acute ischemic stroke.
Low-molecular-weight heparin (LMWH) vs unfractionated heparin (UFH) for the prevention of venous thromboembolism (VTE) after ischemic stroke*
*Abbreviations defined in Glossary. Weighted event rates, RRR, RRI, NNT, NNH and CI calculated from odds ratios in article and unweighted event rates provided by author.
Ken Uchino. Review: Low-molecular-weight heparin is better than unfractionated heparin to prevent VTE after ischemic stroke. Ann Intern Med. 2008;149:JC1–8. doi: 10.7326/0003-4819-149-2-200807150-02008
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Published: Ann Intern Med. 2008;149(2):JC1-8.
Neurology, Stroke, Venous Thromboembolism.
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