Abstract | BACKGROUND: METHODS: Reviewers (A.F.M. and S.M.M.) identified studies by searching MEDLINE, reviewing references from retrieved articles, scanning abstracts from conference proceedings, and contacting investigators and pharmaceutical companies. Randomized trials comparing low-molecular-weight heparin administered at different times relative to surgery with oral anticoagulants in patients undergoing elective hip arthroplasty, evaluated using contrast phlebography, were selected. Two reviewers (A.F.M. and S.M.M.) extracted data independently. RESULTS: The literature review identified 4 randomized trials meeting predefined inclusion criteria. The results indicate that low-molecular-weight heparin initiated in close proximity to surgery resulted in absolute risk reductions of 11% to 13% for deep vein thrombosis, corresponding to relative risk reductions of 43% to 55% compared with oral anticoagulants. Low-molecular-weight heparin initiated 12 hours before surgery or 12 to 24 hours postoperatively was not more effective than oral anticoagulants. Low-molecular-weight heparin initiated postoperatively in close proximity to surgery at half the usual dose was not associated with a clinically or statistically significant increase in major bleeding rates (P =.16). CONCLUSIONS:
|
Authors | R D Hull, G F Pineo, P D Stein, A F Mah, S M MacIsaac, O E Dahl, W A Ghali, M S Butcher, R F Brant, D Bergqvist, K Hamulyák, C W Francis, V J Marder, G E Raskob |
Journal | Archives of internal medicine
(Arch Intern Med)
Vol. 161
Issue 16
Pg. 1952-60
(Sep 10 2001)
ISSN: 0003-9926 [Print] United States |
PMID | 11525697
(Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
|
Chemical References |
- Anticoagulants
- Heparin, Low-Molecular-Weight
|
Topics |
- Administration, Oral
- Anticoagulants
(administration & dosage)
- Arthroplasty, Replacement, Hip
(adverse effects)
- Drug Administration Schedule
- Elective Surgical Procedures
(adverse effects)
- Heparin, Low-Molecular-Weight
(administration & dosage)
- Humans
- Injections, Subcutaneous
- Odds Ratio
- Randomized Controlled Trials as Topic
- Research Design
- Risk
- Venous Thrombosis
(etiology, prevention & control)
|