DSEN Abstract
Direct oral anticoagulants for the prevention of venous thromboembolic events in the hospital setting
Summary and key messages
Summary
- LMWH is more effective than UFH in preventing VTE among hospitalized medical patients, without added bleeding risk.
- In surgical patients, LMWH may raise minor bleeding risk, with similar efficacy to UFH. Evidence is based primarily on one RCT.
- No evidence for DOACs was identified.
Key messages
- LMWH could be considered for VTE prophylaxis in medical inpatients.
- More studies are needed in surgical patients and to evaluate the role of DOACs in thromboprophylaxis.
Authors: Shannon Kelly, Jesse Elliott, Marc Carrier, William Geerts, Agnes Y. Y. Lee, Amy Johnston, Zemin Bai, Becky Skidmore, George A. Wells
PROSPERO: CRD42015026946
For more information, please contact:
George A. Wells
gawells@ottawaheart.ca
What is the issue?
- Venous thromboembolism (VTE) is a major preventable cause of morbidity and mortality among hospitalized patients.
- Pharmacologic thromboprophylaxis options include unfractionated heparin (UFH), low molecular weight heparin (LMWH) and direct oral anticoagulants (DOACs).
- LMWH is increasingly used due to clinical benefits such as reduced heparin-induced thrombocytopenia (HIT) risk and ease of administration.
What was the aim of the study?
- The aim of this systematic review was to assess the comparative efficacy and safety of LMWH versus UFH in preventing VTE among hospitalized medical and non-orthopedic surgical patients.
How was the study conducted?
- A systematic review and meta-analysis of randomized controlled trials, supported by expert consultation.
- Included adult populations received LMWH or UFH; surgical studies also considered use of DOACs. Outcomes of interest included VTE, deep vein thrombosis (DVT), pulmonary embolism (PE), bleeding (major, minor, intracranial), HIT and death.
What did the study find?
- In medical patients:
- LMWH significantly reduced the risk of VTE, DVT and PE.
- There was no difference between LMWH and UFH in the risk of bleeding or death.
- Stroke patients derived more benefit from LMWH than non-stroke patients.
- In surgical patients:
- No differences between LMWH and UFH in the risks of VTE, DVT, PE or death.
- LMWH was associated with a higher risk of minor bleeding, with no difference in major bleeding.
- HIT was not reported in any included trial.
- DOACs were not represented in the eligible surgical trials.
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