Weight-adjusted versus fixed dose heparin thromboprophylaxis in hospitalized obese patients: A systematic review and meta-analysis
| Autor: | Roberto Vettor, Claudio Pagano, Davide Ceccato, Raffaele Pesavento, Paolo Prandoni, Angelo Di Vincenzo |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.drug_class Population Low molecular weight heparin 030204 cardiovascular system & hematology Lower risk 03 medical and health sciences 0302 clinical medicine Internal medicine Internal Medicine medicine Humans Obesity Prospective Studies cardiovascular diseases 030212 general & internal medicine Anti-Xa levels Heparin Thromboprophylaxis Venous thromboembolism Anticoagulants Heparin Low-Molecular-Weight Retrospective Studies Venous Thromboembolism education education.field_of_study business.industry Anticoagulant Low-Molecular-Weight Odds ratio medicine.disease Meta-analysis business medicine.drug |
| Zdroj: | European Journal of Internal Medicine. 88:73-80 |
| ISSN: | 0953-6205 |
| Popis: | Fixed dose unfractionated or low molecular weight heparin is the recommended treatment for venous thromboembolism (VTE) prevention in hospitalized patients. However, its efficacy has been questioned in obese population. Results of previous studies on weight-adjusted doses of heparin for VTE prevention are contradictory. Different anticoagulant regimens are used in clinical practice, but their role remains to be elucidated.To clarify the efficacy and safety of weight-adjusted dose heparin for VTE prevention in obese subjects hospitalized for medical and surgical conditions.Twelve studies were identified as reporting VTE occurrence, major or minor bleeding and anti-Xa levels. A random-effect meta-analysis was conducted to derive odds ratios (OR) comparing fixed vs weight adjusted-doses heparins on VTE occurrence, bleeding, anti-Xa levels. Medical and surgical patients, prospective vs retrospective and quality of studies were extracted for moderators and meta-regression analysis.Weight-adjusted dose heparin administration was not associated with reduced VTE occurrence (6320/13317 patients, OR 1.03, 95% C.I. 0.79 to 1.35), nor increased bleeding (5840/10906 patients, OR 0.84, 95% C.I. 0.65 to 1.08), but it was associated with higher anti-Xa levels (284/294 patients, ES 2.04, 95% C.I. 1.16 to 2.92, p0.0001). A significant heterogeneity was present for comparison of anti-Xa levels (IWeight-adjusted dose as compared to fixed-dose of heparins in the prevention of VTE in obese patients was not associated with a lower risk of VTE nor a higher risk of bleeding. |
| Databáze: | OpenAIRE |
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