Meta-analysis and systematic review of randomized controlled trials assessing the role of thromboprophylaxis after vascular surgery
| Autor: | Chandler A. Long, Yazan Zayed, Tarek Haykal, Thomas L. Ortel, Smit Deliwala, Josiane Kerbage |
|---|---|
| Rok vydání: | 2022 |
| Předmět: |
Male
medicine.medical_specialty medicine.drug_class Population Low molecular weight heparin Hemorrhage Placebo law.invention Randomized controlled trial law Internal medicine medicine Humans education Randomized Controlled Trials as Topic education.field_of_study Heparin business.industry Anticoagulants Venous Thromboembolism Heparin Low-Molecular-Weight Middle Aged Vascular surgery medicine.disease Pulmonary embolism Venous thrombosis Relative risk Female Surgery Pulmonary Embolism Cardiology and Cardiovascular Medicine business Vascular Surgical Procedures |
| Zdroj: | Journal of Vascular Surgery: Venous and Lymphatic Disorders. 10:767-777.e3 |
| ISSN: | 2213-333X |
| Popis: | Background Venous thromboembolism (VTE) is a well-known complication associated with surgical procedures. The implementation of thromboprophylaxis in this population has become a vital aspect of perioperative care to decrease VTE-associated morbidity and mortality risk. However, data assessing the role of thromboprophylaxis for patients undergoing vascular surgery are sparse. Assessing the role of thromboprophylaxis by low-molecular-weight heparin or unfractionated heparin in vascular surgery. Methods We searched MEDLINE, Embase, and the Cochrane Collaboration Central Register of Controlled Trials from inception until December 2020, for randomized controlled trials assessing the role of thromboprophylaxis in vascular surgery. Results Eight randomized controlled trials met inclusion criteria, including 3130 patients, with a mean age of 55.35 years and 45% were females. Compared with placebo, anticoagulant use was associated with a decrease in deep venous thrombosis (DVT) (risk ratio [RR], 0.34; 95% confidence interval [CI], 0.11-1.05; P = .06; I2 = 68%) and pulmonary embolism (PE) (RR, 0.17; 95% CI, 0.02-1.22; P = .08; I2 = 41%), but this trend did not attain statistical significance. There was no difference for bleeding outcomes between anticoagulants and placebo (RR, 0.90; 95% CI, 0.05-15.01; P = .94; I2 = 76%). There was no significant difference in outcomes when low-molecular-weight heparin was compared directly with unfractionated heparin. In a sensitivity analysis, anticoagulant use was associated with a significant decrease in DVT or PE in patients undergoing venous surgeries, but was not associated with a significant decrease in DVT or PE in patients undergoing arterial surgeries, although this analysis was limited by the small number of studies in each group. Conclusions Among patients undergoing vascular surgery, thromboprophylaxis with anticoagulants showed a trend toward a lesser incidence of VTE when compared with placebo, although this difference was not statistically significant. Bleeding outcomes were comparable between both treatment groups. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect