| SQ unfractionated heparin is as efficacious for acture thromboembolism as low-molecular weight venous thromboembolism is as effective for initial treatment of acute venous thromboembolism as is low-molecular weight heparin. |
Citation/s:
Lead author's name and fax: Kearon, C.
Three-part Clinical Question: Is fixed-dose, weight-adjusted.
subcutaneous unfractionated heparin as effective and safe as low-molecular
weight heparin for treatment of venous thromboembolism?
Search Terms:
venous throboembolsim, low-molecular weight heparin, unfractioned heparin
The Study:
Non-blinded randomised controlled trial without
intention-to-treat.
The Study Patients: 18 years or older Acute venous
thromboembolism No shock or major surgery in past 24 hours life expectancy of
greater than 3 months Not receiving long term anticoagulation creatinine less
than 2.4 mg/dL
Control group (N = 353; 352 analysed): Low molecular
weight heparin at 100 IU/kg for 5 days or until INR was 2.0 or higher for 2
consecutive days.
Experimental group (N = 355; 345 analysed):
Unfractionated heparin first dose of 333U/kg followed by 250 U/kg for 5 days or
until INR was 2.0 or higher for 2 consecutive days.
The Evidence:
| Outcome | Time to Outcome | CER | EER | RRR | ARR | NNT |
| Recurrent venous thromboembolism | 0.034 | 0.037 | -9% | -0.003 | -333 | |
|---|---|---|---|---|---|---|
| 95% Confidence Intervals: | -89% to 71% | -0.030 to 0.024 | NNT = 41 to INF; NNH = 33 to INF | |||
| Major bleed | 0.034 | 0.017 | 50% | 0.017 | 59 | |
| 95% Confidence Intervals: | -18% to 100% | -0.006 to 0.040 | NNT = 25 to INF; NNH = 161 to INF | |||
| major or minor bleeding | 0.085 | 0.082 | 4% | 0.003 | 333 | |
| 95% Confidence Intervals: | -44% to 51% | -0.038 to 0.044 | NNT = 23 to INF; NNH = 26 to INF | |||
| Non-Event Outcomes | Time to outcome/s | Control group | Experimental group | P-value |
|---|---|---|---|---|
| Death | 18 | 22 |
Comments:
While this study does not address long term treatment of
thromboembolism with unfractionated SQ heparin, it does provide evidence for
initial treatment. More studies need to be conducted.
Appraised by: Jim Bridges 1718 Patterson ST Nashville, TN 37203 ; Monday,
April 09, 2007
Email: jbridges@alivehospice.org
Kill or Update By:
April 11, 2008