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Cochrane Database of Systematic Reviews

Administración de heparina subcutánea lenta versus rápida para la prevención de la equimosis y la intensidad del dolor en el sitio de inyección

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view the current version 08 June 2021

Information

DOI:
https://doi.org/10.1002/14651858.CD008077.pub5Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 01 November 2017see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:

  1. Cochrane Vascular Group

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Mina Mohammady

    Correspondence to: Department of Nursing, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran

    [email protected]

    [email protected]

  • Leila Janani

    Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran

  • Ali Akbari Sari

    Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

Contributions of authors

MM: design of the review; literature search and identification of trials for inclusion; evaluation of methodological quality of included trials; data extraction; contact with trial authors; interpretation of data; writing of the draft review; and assuming responsibility for writing of future updates.
LJ: design of the review; literature search and identification of trials for inclusion; evaluation of methodological quality of included trials; data extraction; interpretation of data; and writing the review.
AAS: design of the review; methodological advice; writing of the review; overall supervision.

Sources of support

Internal sources

  • Tehran University of Medical Sciences, Tehran, Iran.

External sources

  • Chief Scientist Office, Scottish Government Health Directorates, The Scottish Government, UK.

    The Vascular Group editorial base is supported by the Chief Scientist Office.

Declarations of interest

MM: none known.
LJ: none known.
AAS: none known.

Acknowledgements

We would like to thank Cochrane Vascular for extensive and kind support provided, and Dr Saharnaz Nedjat for input into the previous version of this review.

Version history

Published

Title

Stage

Authors

Version

2021 Jun 08

Slow versus fast subcutaneous heparin injections for prevention of bruising and site pain intensity

Review

Mina Mohammady, Maryam Radmehr, Leila Janani

https://doi.org/10.1002/14651858.CD008077.pub6

2017 Nov 01

Slow versus fast subcutaneous heparin injections for prevention of bruising and site pain intensity

Review

Mina Mohammady, Leila Janani, Ali Akbari Sari

https://doi.org/10.1002/14651858.CD008077.pub5

2017 Oct 01

Slow versus fast subcutaneous heparin injections for prevention of bruising and site pain intensity

Review

Mina Mohammady, Leila Janani, Ali Akbari Sari

https://doi.org/10.1002/14651858.CD008077.pub4

2014 Jul 18

Slow versus fast subcutaneous heparin injections for prevention of bruising and site‐pain intensity

Review

Ali Akbari Sari, Leila Janani, Mina Mohammady, Saharnaz Nedjat

https://doi.org/10.1002/14651858.CD008077.pub3

2010 Feb 17

Slow versus fast subcutaneous heparin injections for prevention of bruising and site‐pain intensity

Protocol

Mina Mohammady, Leila Janani, Ali Akbari Sari, Saharnaz Nedjat

https://doi.org/10.1002/14651858.CD008077.pub2

2009 Oct 07

Slow versus fast subcutaneous heparin injections for prevention of bruising and site‐pain intensity

Protocol

Mina Mohammady, Leila Janani, Ali Akbari Sari, Saharnaz Nedjat, Seyyed Meisam Ebrahimi

https://doi.org/10.1002/14651858.CD008077

Differences between protocol and review

The protocol stated that this review would include randomised controlled trials, clinical controlled trials, and quasi‐experimental studies. However, on the basis of discussions with the Vascular Group editorial base, review authors agreed to exclude clinical controlled trials and quasi‐experimental studies to reduce risk of bias.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans; Middle Aged;

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Slow versus fast heparin injections, Outcome 1 Intensity of injection pain.
Figures and Tables -
Analysis 1.1

Comparison 1 Slow versus fast heparin injections, Outcome 1 Intensity of injection pain.

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Comparison 1 Slow versus fast heparin injections, Outcome 2 Bruise size 48 hours after injection.
Figures and Tables -
Analysis 1.2

Comparison 1 Slow versus fast heparin injections, Outcome 2 Bruise size 48 hours after injection.

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Comparison 1 Slow versus fast heparin injections, Outcome 3 Bruise size.
Figures and Tables -
Analysis 1.3

Comparison 1 Slow versus fast heparin injections, Outcome 3 Bruise size.

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Summary of findings for the main comparison. Slow versus fast subcutaneous heparin injection for prevention of bruising and site pain intensity

Slow vs fast subcutaneous heparin injection for prevention of bruising and site pain intensity

Patient or population: patients treated with subcutaneous heparin injections

Settings: hospital outpatient and inpatient units

Intervention: slow injection (injection speed of 20 or more seconds)

Comparison: fast injection (injection speed of less than 20 seconds)

Outcomes

Illustrative comparative risks* (95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk with fast injection

Corresponding risk with slow injection

Intensity of injection pain

immediately after injection

(VAS 0 to 10 cm)

0 (no pain) to 10 (worst possible pain)

Mean pain intensity reported by the 2 studies ranged across fast injection groups from 2 to 5.

Mean pain intensity in the slow injection group was 1.52 points less than in the fast group (3.56 lower to 0.53 higher; P = 0.15).

140
(2 RCTs)

⊕⊕⊝⊝a
low

Intensity of injection pain

48 hours after injection

(VAS 0 to 10 cm)

0 (no pain) to 10 (worst possible pain)

Mean pain intensity ranged across fast injection groups from 2.1 to 2.8.

Mean pain intensity in the slow injection group was 1.68 points less than in the fast group (2.91 lower to 0.45 lower; P = 0.007).

59
(2 RCTs)

⊕⊕⊝⊝b
low

Bruise size

48 hours after injection

(mm/mm2)

See comment.

Mean bruising size in the slow injection group was 0.6 SD lower than in the fast injection group (1.24 lower to 0.04 higher; P = 0.07).

459
(4 RCTs)

⊕⊕⊝⊝c
low

Bruise size was measured on different scales; therefore we used the SMD to pool data.

Haematoma at injection site

See comment.

No studies measured this outcome.

*The basis for the assumed risk (e.g. median control group risk across studies) for pain intensity was the range of mean pain score reported following fast injection by the 2 studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the mean difference of the intervention (and its 95% CI).
CI: confidence interval; cm: centimetre; mm: millimetre; RCTs: randomised controlled trials; SD: standard deviation; SMD: standardised mean difference; VAS: visual analogue scale.

GRADE Working Group grades of evidence.
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

aWe downgraded the quality of evidence by two steps owing to study limitations, as we identified few studies with small numbers of participants (imprecision) and high heterogeneity (I2 = 73%) (inconsistency).
bWe downgraded the quality of evidence by two steps owing to study limitations, as we identified few studies with small numbers of participants (imprecision) and high heterogeneity (I2 = 72%) (inconsistency).
cWe downgraded the quality of evidence by two steps owing to study limitations, as we identified few studies with small numbers of participants (imprecision) and high heterogeneity (I2 = 85%) across studies (inconsistency).

Figures and Tables -
Summary of findings for the main comparison. Slow versus fast subcutaneous heparin injection for prevention of bruising and site pain intensity
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Comparison 1. Slow versus fast heparin injections

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Intensity of injection pain Show forest plot

3

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Immediately after each injection

2

140

Mean Difference (IV, Random, 95% CI)

‐1.52 [‐3.56, 0.53]

1.2 48 hours after injection

2

59

Mean Difference (IV, Random, 95% CI)

‐1.68 [‐2.91, ‐0.45]

1.3 60 hours after injection

1

40

Mean Difference (IV, Random, 95% CI)

‐1.0 [‐2.15, 0.15]

1.4 72 hours after injection

1

40

Mean Difference (IV, Random, 95% CI)

‐0.8 [‐1.70, 0.10]

2 Bruise size 48 hours after injection Show forest plot

4

459

Std. Mean Difference (IV, Random, 95% CI)

‐0.60 [‐1.24, 0.04]

2.1 Bruise size (mm2)

2

140

Std. Mean Difference (IV, Random, 95% CI)

‐0.30 [‐0.64, 0.03]

2.2 Bruise size (mm)

2

319

Std. Mean Difference (IV, Random, 95% CI)

‐1.69 [‐5.07, 1.70]

3 Bruise size Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 60 hours after injection (mm2)

1

40

Mean Difference (IV, Fixed, 95% CI)

‐3.85 [‐8.99, 1.29]

3.2 72 hours after injection (mm2)

2

140

Mean Difference (IV, Fixed, 95% CI)

‐2.29 [‐6.57, 1.99]
Figures and Tables -
Comparison 1. Slow versus fast heparin injections
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