Richard H. White, MD
What is the relative efficacy of prophylactic mechanical compression and subcutaneous heparin for preventing venous thromboembolism (VTE) after surgery or trauma? Do treatments differ for risk for bleeding?
Included studies compared prophylactic mechanical compression and subcutaneous heparin (low-molecular-weight or unfractionated) in patients who were having surgery or were admitted to hospital immediately after trauma. Studies comparing combined treatments with either treatment alone or evaluating heparin combined with other agents were excluded. The primary outcome was deep venous thrombosis (DVT); secondary outcomes were pulmonary embolism and bleeding.
MEDLINE and EMBASE/Excerpta Medica (to Nov 2008) and reference lists were searched for randomized controlled trials (RCTs). Experts were contacted. 16 RCTs (n = 4828 recruited) met the selection criteria. 6 RCTs used blinding for radiologists who assessed DVT. Follow-up ranged from 5 days to 3 months. 8 RCTs used low-molecular-weight heparin, and 8 used unfractionated heparin; 16 used compression (pneumatic, foot pump, or stockings). Results were pooled using a random-effects model.
Meta-analysis showed that mechanical compression and subcutaneous heparin did not differ for prevention of DVT or pulmonary embolism; heparin increased risk for bleeding (Table). Prespecified subgroup analysis showed that mechanical compression increased risk for DVT more than low-molecular-weight heparin (relative risk [RR] 1.80, 95% CI 1.16 to 2.79); mechanical compression and unfractionated heparin did not differ (RR 0.71, 95% CI 0.42 to 1.19).
Compared with mechanical compression, subcutaneous heparin increases bleeding but does not reduce venous thromboembolism in postoperative and trauma patients.
Mechanical compression vs subcutaneous heparin after surgery or trauma*
*Abbreviations defined in Glossary. Weighted event rates, RRI, RRR, NNH, NNT, and CI calculated from data in article using a random-effects model.
†Information provided by author.
Richard H. White. Review: Heparin and mechanical compression are similar in reducing postsurgical VTE risk, but heparin increases bleeding. Ann Intern Med. 2010;153:JC1–7. doi: 10.7326/0003-4819-153-2-201007200-02007
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Published: Ann Intern Med. 2010;153(2):JC1-7.
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