Unfractionated Heparin Vs Enoxaparin Thromboprophylaxis in Medical-Surgical Patients: A Systematic Review and Meta-Analysis
Notice bibliographique
Résumé
Background: In critically ill patients, thromboprophylaxis is vital for preventing venous thromboembolism. Unfractionated heparin (UH) and enoxaparin (EP) can differ in the prognostic outcomes of the patients. This meta-analysis aims to compare the efficacy and safety of UH versus EP in terms of mortality, incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), overall Venous Thromboembolism (VTE), and post-treatment bleeding. Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. A comprehensive literature search was performed across PubMed, Embase, and Cochrane Library databases up to July 2024 for studies comparing outcomes between unfractionated heparin and enoxaparin. The analysis included 13 studies including 5 retrospective cohort studies, 1 prospective cohort study, and 7 randomized clinical trials. Inclusion criteria were adults (≥18 years old) and studies published in English, randomized controlled trials (RCTs), cohort studies, case-control studies, and cross-sectional studies. Exclusion criteria included patients (<18 years old), patients on warfarin therapy, hospital stays of ≤2 days, studies not involving UFH or LMWH for VTE prophylaxis, and non-original studies. The quality assessment was conducted independently by two reviewers using the New-castle Ottawa scale and Cochrane RoB2. The outcomes included bleeding complications, mortality, VTE, PE, and DVT. A random-effects meta-analysis assessed odds ratio (ORs) and 95% confidence intervals to compare all the outcomes between these two groups. Results: Out of the 13 included studies, 65331 participants were included with a female predominance of 51.68%. The mean age of the population is 65.16 (12.85) years. The total number of patients on UFH is 29858 and the total number of patients on enoxaparin is 36180. Our meta-analysis yielded the following results: There was comparable mortality between UH and EP [OR =1.19, 95% CI: 0.91 - 1.55, p = 0.20]. Similar incidence rates were reported for Deep Vein Thrombosis (DVT) [OR = 1.81, 95% CI: 0.87 - 3.78, p = 0.11] and Pulmonary Embolism (PE) [OR = 1.62, 95% CI: 0.62 - 4.21, p = 0.32], suggesting no significant difference between the two groups. There were comparable incidence rates for venous thromboembolism (VTE) [OR = 2.19, 95% CI: 0.88 - 5.45, p = 0.09], between UH and EP. Post-treatment bleeding had an OR of 1.08 [95% CI: 0.82 - 1.44, p = 0.58], showing no significant difference in post-treatment bleeding between the two treatments. However, sensitivity analysis by one study removal method showed increased odds of DVT [OR = 1.24, 95% CI, 1.03 - 1.49, p = 0.02] and VTE [OR = 1.30, 95% CI: 1.08 - 1.56, p = 0.01] rates for UH. Conclusion: Our meta-analysis showed no statistically significant differences between unfractionated heparin and enoxaparin for mortality, DVT, PE, VTE, and post-treatment bleeding. Although sensitivity analysis with one-study removal shows higher rates of DVT and VTE for UH, the results showed that one study should be carefully interpreted, considering one study as a confounder. Clinicians should consider these findings with caution and evaluate patient-specific factors when choosing between UH and EP for thromboprophylaxis in critically ill patients.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,013 | 0,023 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,002 |
| Méta-épidémiologie (sens large) | 0,022 | 0,045 |
| Bibliométrie | 0,008 | 0,008 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,003 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».