Low molecular weight heparin in one or two doses for the initial treatment of venous thromboembolic disease?

Medwave. 2015 Nov 20:15 Suppl 3:e6320. doi: 10.5867/medwave.2015.6320.
[Article in English, Spanish]

Abstract

The preferred dosification for low molecular weight heparins is in two doses for most patients with venous thromboembolic disease. A daily dose would make treatment simpler, less expensive and more comfortable while retaining a similar benefit and safety. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified two systematic reviews including five randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded it is not clear whether the risk of recurrence differs between the two alternatives because the certainty of the evidence is very low, and that administering low molecular weight heparin in two doses might be associated to little or no difference in the risk of major bleeding and mortality.

La heparina de bajo peso molecular administrada cada 12 horas es el tratamiento inicial de elección para muchos pacientes con enfermedad tromboembólica. Sin embargo, la administración cada 24 horas podría facilitar el manejo, disminuir costos y mejorar el confort del paciente manteniendo los mismos beneficios y seguridad. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos dos revisiones sistemáticas que en conjunto incluyen cinco estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que la certeza de la evidencia es muy baja para determinar si el riesgo de recurrencia es similar entre ambas opciones y que la administración en dos dosis al día podría asociarse a poca o nula disminución en el riesgo de hemorragia mayor y mortalidad.

Publication types

  • Meta-Analysis

MeSH terms

  • Anticoagulants / administration & dosage*
  • Anticoagulants / adverse effects
  • Anticoagulants / therapeutic use
  • Drug Administration Schedule
  • Hemorrhage / chemically induced
  • Heparin, Low-Molecular-Weight / administration & dosage*
  • Heparin, Low-Molecular-Weight / adverse effects
  • Heparin, Low-Molecular-Weight / therapeutic use
  • Humans
  • Randomized Controlled Trials as Topic
  • Recurrence
  • Venous Thromboembolism / drug therapy*
  • Venous Thromboembolism / prevention & control

Substances

  • Anticoagulants
  • Heparin, Low-Molecular-Weight